Small Cell Lung Cancer: Etoposide Capsules in combination with other approved chemotherapeutic agents as first line treatment in patients with small cell lung cancer. Etoposide is also indicated in Testicular cancer, Small cell lung cancer.
Pharmacodynamics: Pharmacotherapeutic classification: podophyllotoxin derivatives. Etoposide is a semisynthetic derivative of podophyllotoxin used in the treatment of certain neoplastic diseases. Podophyllotoxins inhibit mitosis by blocking microtubular assembly. Etoposide inhibits cell cycle progression at a premitotic phase (late S and G2). It does not interfere with the synthesis of nucleic acids.
Pharmacokinetics: On intravenous administration, the disposition of etoposide is best described as a biphasic process with a distribution half-life of about 1.5 hours and terminal elimination half-life ranging from 4 to 11 hours. Total body clearance values range from 33 to 48 ml/min or 16 to 36 ml/min/m 2 and, like the terminal elimination half-life, are independent of dose over a range 100-600 mg/m2. Over the same dose range, the areas under the plasma concentration vs time curves (AUC) and the maximum plasma concentration (Cmax) values increase linearly with dose. Etoposide does not accumulate in the plasma following daily administration of 100 mg/m 2 for 4 to 5 days.The mean volumes of distribution at steady state fall in the range of 18 to 29 liters or 7 to 17 L/m2
Intravenous (Adult)- Small cell lung cancer: 35 mg/m2/day for 4 days to 50 mg/m2/day for 5 days. May repeat course at 3-4 wkly intervals after recovery from any toxicity. Inj must be diluted with 5% dextrose or normal saline to give a final concentration of 0.2-0.4 mg/ml and injected over 30-60 minutes. When given via oral capsules: the recommended dose is twice the IV dose rounded to the nearest 50 mg. Testicular cancer: For combination therapy: 50-100 mg/m2/day from days 1-5, or 100 mg/m2 on days 1, 3 and 5. May repeat course at 3-4 wkly intervals after recovery from any toxicity. Inj must be diluted with 5% dextrose or normal saline to give a final concentration of 0.2-0.4 mg/ml and injected over 30-60 minutes. Oral (Adult)- Small cell lung cancer: Twice the IV dose, rounded to the nearest 50 mg.
High-dose cyclosporine a resulting in concentrations above 2000 ng/ml administered with oral Etoposide has led to an 80% increase in Etoposide exposure with a 38% decrease in total body clearance of etoposide compared to Etoposide alone.
Laboratory Tests: Periodic complete blood counts should be done during the course of Etoposide treatment. They should be performed prior to each cycle of therapy and at appropriate intervals during and after therapy. At least one determination should be done prior to each dose of Etoposide.
Hypersensitivity, pregnancy, lactation. Skin reactions may occur with accidental exposure; renal or hepatic disease. Periodic CBCs should be done before, during and after therapy. Increased risk of etoposide-toxicity in patients with low serum albumin. Acrylic material has been shown to crack and leak when used with undiluted etoposide inj.
Leukopenia, Nausea and Vomiting, Thrombocytopenia, Alopecia, Anorexia, Diarrhea, Leukopenia, Anemia, Pancytopenia, Stomatitis, Hepatic toxicity, Type 1 hypersensitivity, Orthostatic hypotension, Peripheral neuropathy Malaise,Shivering,Asthenia,Fever,Mucous membrane inflammation, Hyperuricemia, Local soft tissue toxicity has been reported following extravasation.
Pregnancy category D. There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Lactation: not known if excreted in breast milk, discontinue drug or do not nurse.
Must be stored under refrigeration 2°-8°C. The capsules are stable for 24 months under such refrigeration conditions. Keep all medicines out of reach of children. Protect from light. Procedure for proper handling and disposal of anticancer drugs should be considered.
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