Cisplatin and Etoposide Chemotherapy Regimen - Small Cell Lung Cancer Treatment

How Does Cisplatin+Etoposide Work?

Cisplatin + etoposide chemotherapies are designed to kill cancer cells and prevent their division into new cells by damaging their DNA.

Purpose of Treatment

Cisplatin + etoposide is commonly given as first-line treatment for small cell lung cancer. However, this cancer frequently recurs, and second-line treatments may then be recommended.

Administration, Dose and Schedule

• Cisplatin 60 - 80 mg/m2 is given on day 1 intravenously (intraVenous = İ.V.), slowly over 2 hours. Giving medication through a vein over a specified period is called an infusion.
• Etoposide 100 - 120 mg/m2 is given on days 1., 2. and 3. as an infusion over 30 minutes.

Typically, these two drugs are given consecutively on the same day. Cisplatin + etoposide is generally administered in outpatient chemotherapy units, and patients return home afterward. The first treatment day may exceed five hours.

If radiotherapy is used, it may be given before or after each daily dose. Rarely, newly diagnosed patients may receive radiotherapy before the first cycle.

Cisplatin + etoposide is repeated every 21 days, an interval known as a treatment cycle. Cycles may be repeated 4 to 6 times depending on response and chemotherapy tolerance.

Your doctor may recommend radiation treatment in addition to chemotherapy.

Side Effects

In multidrug regimens, each drug has its own side effects, and combining two drugs may produce additional effects. Frequencies are estimated from clinical trials. The most common side effects associated with cisplatin+etoposide are:

• Anemia (reduced oxygen-carrying red blood cells) (85%)
• Vomiting (60-70%)
• Weight loss (58-68) 
• Bleeding risk due to low platelets (65%)
• Esophageal infection (esophagitis) (37-56%)
• Fever (38-45%)
• Infection (20-27%)

Monitoring

How Often Is Monitoring Needed?

Blood tests must be checked before each chemotherapy cycle. Required tests are a complete blood count, comprehensive metabolic panel (biochemistry) and blood magnesium level. Other blood tests may be added according to physician advice.

How Often Is Imaging (Radiological Examination) Needed?

Imaging is performed before treatment and generally after four to six chemotherapy cycles. Chest X-ray, magnetic resonance imaging (MRI), computed tomography (CT) or positron emission tomography (PET) are among the imaging methods used.

How Do Blood Test or Imaging Results Affect Treatment?

Depending on results, your doctor may continue cisplatin+etoposide as planned, adjust the dose or change treatment.

Precautions

• Cisplatin may damage the kidneys, usually reversibly. Your doctor monitors blood tests for signs of kidney damage and may give intravenous fluids before or after treatment to protect the kidneys. Tell your physician if you think you need fluids.
• After this combination chemotherapy, patients with a marked fall in defense cells may receive a preventive injection of a blood cell growth factor called GCSF, such as filgrastim, lenograstim or pegfilgastrim.
• Your oncology pharmacist should check for interactions between medications.

Individual Drug Label Information

Cisplatin

Mechanism of Action

• Cisplatin’s effect on cancer cells is linked to its ability to cross-link purine bases in DNA. It interferes with repair mechanisms, causing DNA damage and then triggering programmed cell death, apoptosis .
• Cisplatin is an intravenous (I.V.) infusion typically administered over one to two hours.
• Because cisplatin can damage the kidneys, it is given with plenty of intravenous fluids. 
• Other harms may include low blood counts, nausea, vomiting and hearing loss.
• Dose adjustments may be needed for patients with impaired kidney function or bone marrow toxicity (low blood counts).
• Cisplatin is dangerous to the human fetus. Women must therefore avoid pregnancy while taking it.
• Women must not breastfeed while taking cisplatin.
• It is marketed as Cisplatin, Cisplatinum, Kemoplat and Placis.

General Cisplatin Side Effects

• It may cause kidney problems in older patients.
• Nausea and vomiting may occur within the first 24 hours and continue for another two to five days after treatment. With oncology’s new-generation antinausea drugs , cisplatin-induced nausea can now be managed. 
• Diarrhea 
• Low red blood cell count 
• Hearing problems such as tinnitus may occur, so a hearing test may be performed before treatment. Children should have hearing tests before each dose and for several years after treatment ends. 
• Blood electrolytes such as magnesium, potassium, calcium, sodium and phosphate may decrease. 
• Vision problems may occur and improve after treatment. 
• Liver toxicity may occur and improve after treatment.

- Related topic: Cisplatin, the revolutionary cancer drug, and its surprising story

Etoposide

Mechanism of Action

• Etoposide inhibits DNA topoisomerase II, preventing separated DNA from rejoining. This disrupts cell division during the mitosis -preceding stage, causing critical DNA synthesis errors and potentially programmed cancer cell death, apoptosis.
• Etoposide is an intravenous (I.V.) infusion given over 30 minutes.
• Etoposide interacts with grapefruit juice and may cause unwanted side effects.
• Dose adjustment may be necessary for impaired kidney or liver function. 

General Etoposide Side Effects 

• Temporary hair loss may occur. Hair begins growing again after etoposide treatment ends. 
• Gastrointestinal side effects such as diarrhea, mouth sores and nausea may be common.
• Rarely, it is associated with secondary cancer, generally appearing 2-3 years after treatment.
• Red blood cell counts may decrease.

Small cell lung cancer symptoms and diagnosis