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Etoposide is a medication used in the management and treatment of various cancers such as testicular, prostate, bladder, stomach, and lung cancer. It is in the topoisomerase II inhibitor class of medications. This activity outlines the indications, action, and contraindications for etoposide as a valuable agent in managing various cancers listed above, Hodgkin and non-Hodgkin lymphoma and brain tumors. (and other disorders when applicable). This activity will highlight the mechanism of action, adverse event profile, and other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions) pertinent for members of the healthcare team in the treatment of patients with various cancers, lymphomas, leukemias, and related conditions. Objectives: Identify the common indications for the use of etoposide. Describe the typical adverse effects of etoposide. Review the risk factors for developing toxicity with etoposide. Summarize the importance of improving care coordination amongst the interprofessional team to enhance care coordination for patients receiving etoposide chemotherapy. Access free multiple choice questions on this topic.

Myelosuppression is the dose-limiting toxicity of etoposide.[2] Research data showed alopecia, nausea, vomiting, and stomatitis occurring in 20 to 30% of patients.[2] It can also be involved in drug-induced secondary malignancies, such as acute myelocytic leukemia (t-AML).[1] Etoposide-induced t-AML is associated with the translocation on chromosome 11q23.[1]

Etoposide is a strong chemotherapeutic agent that has a proven record of working against various human malignancies. As the drug's list of expanding clinical uses grows, the healthcare teams should find strategies to improve its administration and effectiveness for patients. Additional research is necessary to consider etoposide as initial therapy in several cancers.[6] Etoposide has already shown therapeutic activity against testicular cancer, small cell carcinoma of the lung, leukemias, lymphomas, and more. As initial therapy, etoposide can potentially reduce the administration of multiple chemotherapeutic agents and thus, reduce side effect profiles for patients undergoing treatment. As research has shown, etoposide is a potent chemotherapeutic agent that is schedule-dependent.[9] The dosing and timing of etoposide make a difference in how effective it is. New research should lean toward considering etoposide against cancers at higher doses and prolonged scheduling.[6] The interprofessional healthcare team should engage the services of an oncology specialized pharmacist to optimize the regimen for maximum therapeutic effect while minimizing adverse effects. [Level 5]