Lastet

Indications

Etoposide is an anticancer (chemotherapy) medicine. It is used, usually together with other cancer medicines, to treat small cell lung cancer, testicular cancer, some lymphomas (cancers of the lymph glands), certain leukaemias, and some other tumours as decided by a cancer specialist.

How It Works

Etoposide blocks an enzyme called topoisomerase II, which cells need to untangle and copy their DNA before dividing. When this enzyme is blocked, breaks build up in the DNA of fast-dividing cells, such as cancer cells, and the cells die. Some fast-dividing healthy cells, such as those in the bone marrow, hair roots and gut lining, are also affected, which explains many side effects.

Dosage and Administration

The dose is worked out by the cancer specialist for each person, usually based on body size, kidney function, blood counts and the treatment plan. The injection is diluted and given slowly into a vein by a doctor or nurse in hospital, usually over at least 30 to 60 minutes. Capsules, when used, are taken exactly as prescribed on set days of each cycle. Never change the dose or schedule yourself. Regular blood tests are needed before each cycle.

Interactions

• Other chemotherapy or radiotherapy can add to bone marrow suppression.
• Ciclosporin can raise Etoposide levels and increase toxicity.
• Phenytoin, Carbamazepine and other enzyme inducers may lower its effect.
• It may increase the effect of Warfarin; blood clotting tests may need checking.
• Live vaccines must not be given during treatment and for some months afterwards.

Tell your cancer team about all medicines, herbal products and supplements you use.

Contraindications

• Allergy to Etoposide or any ingredient of the product.
• Severe bone marrow suppression (very low blood counts) not caused by the cancer.
• Severe liver impairment.
• Breastfeeding.

Side Effects

Common side effects include low white cells (higher infection risk), low platelets (bruising or bleeding), anaemia (tiredness), hair loss, nausea and vomiting, loss of appetite, mouth sores, diarrhoea and tiredness. A drop in blood pressure can occur if the infusion is given too fast.

Less common effects include allergic reactions during the infusion (flushing, chills, wheezing), tingling or numbness in the hands and feet, liver problems and, years later, a small risk of a second blood cancer.

Get urgent medical help if you have a fever of 38°C or higher, chills or signs of infection, unusual bleeding or bruising, black stools, severe vomiting or diarrhoea that stops you drinking, or difficulty breathing, chest tightness or swelling of the face during or after treatment.

Pregnancy and Lactation

Etoposide can harm an unborn baby and must not be used in pregnancy unless the specialist decides it is essential. Women and men should use reliable contraception during treatment and for several months after it, as advised by the cancer team. Do not breastfeed during treatment. Etoposide may reduce fertility; ask about fertility preservation before starting.

Precautions and Warnings

Tell your doctor about any liver or kidney disease, previous chemotherapy or radiotherapy, infections, or low albumin levels. Avoid people with infections where possible, practise good hygiene and report fever promptly. Do not have live vaccines. Medicines like this are prepared and handled with special care by trained staff.

Overdose

An overdose can cause severe bone marrow suppression, mouth sores and other serious toxicity. As it is given under specialist supervision, overdose is managed in hospital with supportive care, blood count monitoring, transfusions and infection treatment as needed.

Therapeutic Class

Antineoplastic (anticancer) agent; podophyllotoxin derivative, topoisomerase II inhibitor.

Storage

Store as directed on the pack, away from light and out of the reach of children. Injection vials are usually kept below 25°C; some capsule products are kept in a refrigerator at 2 to 8°C, do not freeze. Diluted infusions are prepared and used by hospital staff.