Care During Chemotherapy and Beyond
Trade names: Toposar®, VePesid®, Etopophos®
Other name: VP-16, Etoposide phosphate
Drug type: Etoposide is an anti-cancer ("antineoplastic"
or "cytotoxic") chemotherapy drug. This medication is classified as a "plant
alkaloid" and "topoisomerase II inhibitor." (For more detail, see "How this
drug works" section below).
What this drug is used for:
- Testicular, bladder, prostate, lung, stomach, and uterine, cancers. Hodgkin's
and non-Hodgkin's lymphoma, mycosis fungoides, Kaposi's sarcoma, Wilm's tumor, rhabdomyosarcoma,
Ewing's sarcoma, neuroblastoma, brain tumors.
- It also may be given as high-dose therapy in bone marrow transplant setting.
Note: If a drug has been approved for one use, physicians
may elect to use this same drug for other problems if they believe it may be helpful.
How this drug is given:
- In tablet form by mouth.
- As an infusion into the vein (intravenous, IV), as a short infusion or as a continuous
infusion over 24 hours.
- Etoposide is considered an irritant. An irritant is a chemical that can cause
inflammation of the vein through which it is given. If the medication escapes
from the vein it can cause tissue damage. The nurse or doctor who gives this
medication must be carefully trained. If you experience pain or notice redness
or swelling at the IV site while you are receiving etoposide, alert your health
care professional immediately.
- The amount of etoposide that you will receive and the method it is given depends
on many factors, including your height and weight, your general health or other
health problems, and the type of cancer or condition being treated. Your doctor
will determine your dose, schedule and how it will be given.
Important things to remember about the side effects of etoposide:
- Most people do not experience all of the side effects listed.
- Side effects are often predictable in terms of their onset and duration.
- Side effects are almost always reversible and will go away after treatment is complete.
- There are many options to help minimize or prevent side effects.
- There is no relationship between the presence or severity of side effects and the
effectiveness of the medication.
- The side effects of etoposide and their severity depend on how much of the drug
is given. In other words, high doses may produce more severe side effects.
The following side effects are common (occurring in greater than 30%)
for patients taking etoposide:
- Low white blood cell count. (This can increase your risk for infection).
- Low platelet count (This can increase your risk of bleeding).
Nadir: Meaning low point, nadir is the point in time between chemotherapy
cycles in which you experience low blood counts.
Onset: 5-7 days
Nadir: 7-14 days
Recovery: 21-28 days
- Menopause (chemotherapy induced)
- Loss of fertility. Meaning, your ability to conceive a child may be affected
by etoposide. Discuss this issue with your health care provider.
- Nausea and vomiting (especially at high-doses)
- Low blood pressure (if the drug is infused too fast)
These side effects are less common, meaning they occur in 10-29 percent
of patients receiving etoposide:
- Mouth sores (especially at high doses)
- Diarrhea (especially at high doses)
- Poor appetite
- Radiation recall (see skin reactions)
Other side effects:
- Metallic taste during infusion of drug
- Inflammation at injection site
- Peripheral neuropathy (numbness in your fingers and toes) may occur with repeated
doses. This is a rare side effect but can be irreversible. Report numbness
or tingling of feet or hands to your health care provider.
- There is a slight risk of developing a blood cancer such as leukemia years after
taking etoposide. Talk to your doctor about this risk.
Not all side effects are listed above, some that are rare (occurring in less than
10% of patients) are not listed here. However, you should always inform your
health care provider if you experience any unusual symptoms.
When to contact your doctor or health care provider:
Contact your health care provider immediately, day or night, if you
should experience any of the following symptoms:
- Fever of 100.4° F (38° C) or higher, chills (possible signs of infection).
The following symptoms require medical attention, but are not an emergency.
Contact your health care provider within 24 hours of noticing any of the
- Nausea (interferes with ability to eat and unrelieved with prescribed medication)
- Vomiting (vomiting more than 4-5 times in a 24 hour period)
- Diarrhea (4-6 episodes in a 24-hour period)
- Unusual bleeding or bruising
- Black or tarry stools, or blood in your stools or urine
- Extreme fatigue (unable to carry on self-care activities)
- Mouth sores (painful redness, swelling or ulcers)
- Swelling, redness and/or pain in one leg or arm and not the other
- Numbness or tingling in your fingers or toes
- Yellowing of the skin or eyes
- Pain, redness or swelling at the IV site
Always inform your health care provider if you experience any unusual symptoms.
- Before starting etoposide treatment, make sure you tell your doctor about any other
medications you are taking (including prescription, over-the-counter, vitamins,
herbal remedies, etc.). Do not take aspirin, products containing aspirin
unless your doctor specifically permits this.
- Do not receive any kind of immunization or vaccination without your doctor's approval
while taking etoposide.
- Inform your health care professional if you are pregnant or may be pregnant prior
to starting this treatment. Pregnancy category D (etoposide may be hazardous
to the fetus. Women who are pregnant or become pregnant must be advised of
the potential hazard to the fetus).
- For both men and women: Do not conceive a child (get pregnant) while taking etoposide.
Barrier methods of contraception, such as condoms, are recommended. Discuss with
your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breast feed while taking this medication.
- Apply warm compresses if you have any pain, redness or swelling at the IV site,
and notify your doctor.
- Drink at least two to three quarts of fluid every 24 hours, unless you are instructed
- You may be at risk of infection so try to avoid crowds or people with colds, and
report fever or any other signs of infection immediately to your health care provider.
- Wash your hands often.
- To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times
a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed
with 8 ounces of water.
- Use an electric razor and a soft toothbrush to minimize bleeding.
- Avoid contact sports or activities that could cause injury.
- To reduce nausea, take anti-nausea medications as prescribed by your doctor, and
eat small, frequent meals.
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided
completely. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition.
- If you experience symptoms or side effects, be sure to discuss them with your health
care team. They can prescribe medications and/or offer other suggestions that
are effective in managing such problems.
Monitoring and testing:
You will be checked regularly by your health care professional while you
are taking etoposide, to monitor side effects and check your response to therapy.
Periodic blood work to monitor your complete blood count (CBC) as well as the function
of other organs (such as your kidneys and liver) will also be ordered by your doctor.
How this drug works:
Cancerous tumors are characterized by cell division, which is no longer controlled
as it is in normal tissue. "Normal" cells stop dividing when they come
into contact with like cells, a mechanism known as contact inhibition. Cancerous
cells lose this ability. Cancer cells no longer have the normal checks and
balances in place that control and limit cell division. The process of cell
division, whether normal or cancerous cells, is through the cell cycle. The
cell cycle goes from the resting phase, through active growing phases, and then
to mitosis (division).
The ability of chemotherapy to kill cancer cells depends on its ability to halt
cell division. Usually, the drugs work by damaging the RNA or DNA that tells
the cell how to copy itself in division. If the cells are unable to divide,
they die. The faster the cells are dividing, the more likely it is that chemotherapy
will kill the cells, causing the tumor to shrink. They also induce cell suicide
(self-death or apoptosis).
Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle
specific. Chemotherapy drugs that affect cells when they are at rest are called
cell-cycle non-specific. The scheduling of chemotherapy is set based on the
type of cells, rate at which they divide, and the time at which a given drug is
likely to be effective. This is why chemotherapy is typically given in cycles.
Chemotherapy is most effective at killing cells that are rapidly dividing.
Unfortunately, chemotherapy does not know the difference between the cancerous cells
and the normal cells. The "normal" cells will grow back and be healthy but in the
meantime, side effects occur. The "normal" cells most commonly affected by
chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and
the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea,
and/or hair loss. Different drugs may affect different parts of the body.
Etoposide belongs to a class of chemotherapy drugs called plant alkaloids.
Plant alkaloids are made from plants. The vinca alkaloids are made from the
periwinkle plant (catharanthus rosea). The taxanes are made from the bark of the
Pacific Yew tree (taxus). The vinca alkaloids and taxanes are also known as
antimicrotubule agents. The podophyllotoxins are derived from the May apple plant.
Camptothecan analogs are derived from the Asian "Happy Tree" (Camptotheca acuminata).
Podophyllotoxins and camptothecan analogs are also known as topoisomerase inhibitors.
The plant alkaloids are cell-cycle specific. This means they attack the cells
during various phases of division.
- Vinca alkaloids: Vincristine, Vinblastine and Vinorelbine
- Taxanes: Paclitaxel and Docetaxel
- Podophyllotoxins: Etoposide and Tenisopide
- Camptothecan analogs: Irinotecan and Topotecan
Topoisomerase inhibitors (such as etoposide) are drugs that interfere with the action
of topoisomerase enzymes (topoisomerase I and II). Topoisomerase enzymes control
the manipulation of the structure of DNA necessary for replication.
- Topoisomerase I inhibitors: Ironotecan, topotecan
- Topoisomerase II inhibitors: Amsacrine, etoposide, etoposide
Note: We strongly encourage you to talk with your health
care professional about your specific medical condition and treatments. The information
contained in this website is meant to be helpful and educational, but is not a substitute
for medical advice.
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