Etoposide (Vepesid)

General information

Class/mechanism: Topoisomerase II inhibitor. Causes DNA strand breaks by interacting with DNA-topoisomerase II or by forming free radicals. Causes arrest at the G2 portion of the cell cycle, with dose dependent effects: at high concentrations, cells entering mitosis undergo lysis; at low concentrations, cells are inhibited from entering prophase.
Route: IV, PO
Extravasation: irritant

For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias or the prescribing information.

Diseases for which it is established

• Ovarian cancer (PMDA)
• Small cell lung cancer (FDA)
• Testicular cancer (FDA)

Scenarios for which it is established

• Cellular therapy conditioning regimens (PMDA)

Diseases for which it is used

• Acute lymphoblastic leukemia, infant
• Acute myeloid leukemia
• Acute promyelocytic leukemia
• Carcinoma of unknown primary
• Adrenocortical carcinoma
• Adult T-cell leukemia-lymphoma
• Anaplastic glioma
• Anaplastic large cell lymphoma
• B-cell acute lymphoblastic leukemia
• T-cell acute lymphoblastic leukemia
• Burkitt lymphoma
• Cholangiocarcinoma
• Classical Hodgkin lymphoma
• CNS lymphoma
• Diffuse large B-cell lymphoma
• Esophageal cancer
  • Esophageal adenocarcinoma
  • Esophageal squamous cell carcinoma
• Ewing sarcoma
• Extranodal NK- and T-cell lymphoma, nasal type
• Gallbladder cancer
• Gestational trophoblastic neoplasia
• Hemophagocytic lymphohistiocytosis
• HIV-associated lymphoma
• Hodgkin lymphoma, nodular lymphocyte-predominant
• Indolent lymphoma
  • Follicular lymphoma
• Kaposi sarcoma
• Langerhans cell histiocytosis
• Low-grade glioma
  • Low-grade glioma, pediatric
• Mantle cell lymphoma
• Mediastinal gray-zone lymphoma
• Medulloblastoma
• Multiple myeloma
• Neuroblastoma
• NK- and T-cell lymphoma
• Non-small cell lung cancer
  • Non-small cell lung cancer, nonsquamous
• Osteosarcoma
• Peripheral T-cell lymphoma
• Primary mediastinal B-cell lymphoma
• Retinoblastoma
• Rhabdomyosarcoma
• Soft tissue sarcoma
• Thymoma
• Transformed lymphoma

Patient drug information

• Etoposide (Vepesid) package insert
• Etoposide (Vepesid) patient drug information (Chemocare)
• Etoposide (Vepesid) patient drug information (UpToDate)

History of changes in FDA indication

• 1983-11-10: Initial FDA approval for refractory testicular tumors. (No supporting studies are cited)
• Uncertain date: Approed for small cell lung cancer, in combination with cisplatin, as first-line treatment. (Based on Hainsworth et al. 1995)

History of changes in EMA indication

• 1980-07-09: EURD

History of changes in PMDA indication

• 2012-02-22: New additional indication and a new dosage for the treatment of ovarian cancer which has progressed after cancer chemotherapy.
• 2019-03-26: New indication for the treatment prior to tumor-specific T-cell infusion therapy.

Also known as

• Code names: VP-16, VP-TEC, VP-16213
• Generic name: etoposide phosphate
• Brand names:

Synonyms
Aside	Beposid	Bioposide	Celltop	Citodox	Epocin	Eposid	Eposide
Eposido	Eposin	Epsidox	ETO	Etocris	Etomedac	Etonolver	Etopofos
Etopophos	Etopos	Etoposid	Etoposido	Etopoxan	Etopul	Etosid	Etosin
Eunades CS	Euvaxon	Exitop	Fytop	Fytosid	Labimion	Lastet	Lastet S
Neoplaxol	Nexvep	Onkoposid	Optasid	Percas	Posid	Posidon	Posyd
Riboposid	Sintopozid	Toposar	Toposide	Toposin	Topresid	Tosuben	Vepefos
Vepesid	Vepeside	Vepsid	Vepside