Etoposide — Drug Monograph

Brand names: VePesid, Toposar, Etopophos

Drug class: Topoisomerase Inhibitor

Mechanism of Action

Semisynthetic podophyllotoxin derivative. Inhibits topoisomerase II by stabilizing the enzyme-DNA cleavage complex, preventing DNA strand re-ligation and causing double-strand DNA breaks. Predominantly S- and G2-phase specific. Oral bioavailability is approximately 50%, and highly variable.

FDA Indications

• Refractory testicular tumors (combination therapy)
• Small cell lung cancer (first-line, combination)

Common Side Effects

• Myelosuppression (leukopenia nadir day 7–14)
• Nausea and vomiting (low-moderate risk)
• Alopecia
• Mucositis
• Hypotension with rapid IV infusion
• Fatigue

Clinical Pearl

Etoposide-induced secondary AML (t-AML) is typically characterized by balanced translocations (11q23, t(3;21), t(15;17)) and occurs earlier than alkylator-induced t-AML (which typically shows deletions/monosomies at chromosomes 5 and 7 and occurs 5–7 years later).

Related Therapies & Mechanisms

• Bendamustine (Treanda) — Lymphoma
• Doxorubicin (Adriamycin) — Lymphoma
• Cyclophosphamide (Cytoxan) — Lymphoma
• Methotrexate (Trexall) — Leukemia