Etoposide Cyclophosphamide

CyEP, cyclophosphamide/etoposide/cisplatin EP, etoposide/cisplatin NCI, National Cancer Institute PIM, cisplatin/ifosfarnide/mitomycin VdP, vindesine/ cisplatin preop., preoperatively postop., postoperatively ChT, chemotherapy NS, not significant. 

Other studies evaluated the question of whether early delivery of radiation concurrently with chemotherapy was better than late delivery. A study performed by the C ALGB randomized patients to early (d 1, cycle 1), late (d 64, cycle 4), or no radiation therapy. The radiation therapy dose was 50 Gy over 6 wk. Chemotherapy used in this trial was cyclophosphamide, etoposide, and vincristine. The local recurrence rate for the early, late, and no radiation therapy arms was 49%, 68%, and 82%, respectively. The 2-yr progression-free survival rate was 15% for the early schedule arm vs 25% for the late schedule (p = 0.078). The 5-yr survival rate for the early, late, and no radiation therapy arms was 6.6%, 12%, and 3%, respectively (p = 0.007). The poor 5-yr survival rate for the early schedule was felt to be due to the significant decrease in chemotherapy dose needed for the early schedule group (4,49). 

Carcinoma of testis Combination chemotherapy cisplatin, bleomycin, and etoposide Methotrexate, dactinomycin, plicamycin, vinblastine, doxorubicin, cyclophosphamide, etoposide, ifosfamide plus mesna1... 

The calcium channel blocker mibefradil (Posicor ) was removed from the market in 1998. The headline for the Pink Sheets article describing this action was "Posicor Withdrawal Reflects Complexity of Interaction Profile" (59). Products identified as potentially dangerous in combination with mibefradil included cardiac drugs, such as amiodarone, flecainide, and propafenone oncologic products, such as tamoxifen, cyclophosphamide, etoposide, ifosfamide, and vinblastine and the immunosuppressant medications cyclosporine and tacrolimus. The sponsor s decision to withdraw mibefradil was based on the complexity of the drug interaction information that would have to be communicated to ensure safe usage. 

In 66 patients who received busulfan in combination with cyclophosphamide, etoposide, and/or cytarabine in preparation for bone marrow transplantation, there was a higher incidence of veno-occlusive disease of the liver (sinusoidal obstruction syndrome) in those who received busulfan + cyclophosphamide (four of 10) than in those who received busulfan + cyclophosphamide + cytarabine (one of 18) or busulfan + cyclophosphamide + etoposide (seven of 38) (24). The risk of veno-occlusive disease was higher in those whose busulfan AUC was over 1500 minute.pmol/l (relative risk = 11). Other pharmacokinetic parameters, age, sex, type of bone marrow transplantation, previous therapy, or pretransplant liver function tests were not predictive of veno-occlusive disease. 

Discrete cutaneous hyperpigmentation occurred in two patients after high-dose chemotherapy with cyclophosphamide, etoposide, and carboplatin (29). 

In a study in 100 patients with newly diagnosed multiple myeloma given induction chemotherapy (dexamethasone, vincristine, doxorubicin, cyclophosphamide, etoposide and cisplatin) with or without thalidomide, deep vein thrombosis developed in 14 of the 50 patients (28%) given thalidomide compared with 2 of 50 patients (4%) not given thalidomide. Deep vein thrombosis has been reported to occur in 10% of patients treated for multiple myeloma but is reported to occur in about 2% in patients with multiple myeloma treated with thalidomide alone. ... 

CAV, cyclophosphamide, doxorubicin, vincristine EC, etoposide carboplatin EP, etoposide cisplatin IC, irinotecan, cisplatin. See Table 87M for doses and schedules. 

BCV (high-dose with autologous stem cell transplant)3 Carmustine 400 mg/m2 IV x 1 day Etoposide 800 mg/m2 IV daily x 3 days Cyclophosphamide 1800 mg/m2 IV daily x 4 days... 

More recently, a German study compared a dose-escalated regimen of BEACOPP (with filgrastim support) with standard-dose bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone, gemcitabine (BEACOPP) and COPP alternating with ABVD (C—cyclophosphamide instead of mechlorethamine for MOPP).18 The escalated BEACOPP was... 

Risk factors for the development of AML include exposure to environmental toxins, Hispanic ethnicity, and genetics.6 Of greater concern is the increased prevalence of AML as a secondary malignancy, resulting from chemotherapy and radiation treatment for other cancers. Alkylating agents, such as ifosfamide and cyclophosphamide, and topoisomerase inhibitors, such as etoposide, are linked to an increased risk of myelodysplastic syndrome (MDS) and AML.8... 

LL, a 47-year-old man, was diagnosed with high-risk diffuse large cell B-cell non-Hodgkin s lymphoma (NHL) 12 months ago. LL had a complete response to his initial treatment of six cycles of RCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). LL is participating in a clinical trial and is randomized to receive a myeloablative autologous HCT TBI days 8 to 5, etoposide day 4, rest day 3, cyclophosphamide day 2, rest day 1, with infusion of autologous PBPC on day 0. 

ABVD, Adriamycin, bleomycin, vinblastine, and dacarbazine BEACOPP, bleomycin, etoposide, Adriamycin, cyclophosphamide, Oncovin, procarbazine, and prednisone CS, clinical stage. 

Standard combination regimens (e.g., CHOP) yield disappointing results. Newer approaches including dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin), and rituximab-containing combination chemotherapy are promising. 

Aflatoxin Bl, bupropion, cyclophosphamide, dexamethasone, etoposide, ifosfamide, midazolam, phenobarbital, propofol, rifampin, teitiposide, thiotepa, vitamin D, xenobiotics Amitriptyhne, carisoprodol,... 

CAV = cyclophosphamide/doxorubicin/vincristine CEV = cyclophosphamide/epirubicin/vincristine CCM = cyclophosphamide/lomustine/methotrexate EA = etoposide/doxorubicin VMV/VAC = vincristine, methotrexate, VP-16/vincristine, doxorubicin, cyclophosphamide VAP = vincristine/doxorubicin/ procarbazine PE = cisplatin/etoposide. 

The NCIC randomized patients to radiation therapy started either early or late with concurrent chemotherapy (cyclophosphamide, doxorubicin, and vincristine alternating with cisplatin and etoposide) (6). The radiation therapy dose was 40 Gy given in 15 fractions over three weeks with the cisplatin and etoposide portion of the chemotherapy. In the early arm the radiation was started on d 21 of cycle 2 (after the first cycle... 

The EORTC randomized patients to either start radiation therapy during wk 6 (early) or after the chemotherapy during wk 14 (late). The chemotherapy regimen used was cyclophosphamide, doxorubicin, and etoposide. The dose of radiation given in the early arm was 50 Gy in 20 fractions in 89 d. The dose of radiation given in the late arm was 50 Gy in 20 fractions in 26 d. No significant differences were noted for local recurrence (50.5% early radiation vs 45.5% late radiation) or 3-yr survival (14% for both early and late radiation therapy) (51). 

P-Carotene has been shown to enhance the cytotoxicity of melphalan and BCNU on human squamous carcinoma cells and of cisplatin and dacarbazine on melanoma cells. In mice with transplanted mammary carcinoma, P-carotene enhanced the antitumor effect of cyclophosphamide, and in mice transplanted with Fsall fibrosarcoma or SCC VII carcinoma, p-carotene enhanced the antitumor effect of melphalan, BCNU, doxorubicin, and etoposide. p-Carotene (5 to 50 mg/kg) has been shown to reduce the genotoxicity of cyclophosphamide in mice and of mitomycin C, methyl methanesulfonate, and bleomycin in cultured cells. P-Carotene also reduced the rate of tumor induction in animals receiving chronic low doses of cyclophosphamide. 

Non-Hodgkin s lymphoma Combination chemotherapy cyclophosphamide, doxorubicin, vincristine, prednisone Bleomycin, lomustine, carmustine, etoposide, interferon, mitoxantrone, ifosfamide, rituximab... 

Drugs used in cancer chemotherapy are cytotoxic drugs, hormones, plant derivatives, radioactive isotopes, and miscellaneous agents (e.g., procarbazine, hydroxyurea, mitotane). The plant-based drugs vincristine, vinblastine, vinorel-bine, etoposide, and campothecins. Radioactive isotopes, such as 131 iodine (131 I), are used in the treatment of thyroid tumors. Cytotoxic drugs (e.g., cis-platin, cyclophosphamide, 6-mercaptopurine, 5-fluorouracil, and methotrexate are used for the treatment of cancer. 

Fig. 3 Venn-diagram for selected compounds interacting with the key MDR-related ABC transporters. MDR-substrate anticancer agents. Abbreviations VCR vincristine, VP-16 etoposide, STER steroids, TAM tamoxiphen, TKI-INHIB tyrosin kinase inhibitors e.g. STI-571, DOX doxorubicine or adriamycin, DNR daunorubicin, EPIR epirubicin, MX mitoxantrone, TOPOT topotecan, iridotecan, BISANT bisanthrone, COLCH colchicin, ACT-D actinomycin D, MYTOM mytomycin, TX methotrexate, CPHAM cyclophosphamide, CHLB chlorambucil, CARM carmustine, LCV leucovorin, HUR hydroxy urea, CISPL cisplatin, TAXOL paclitaxel. (Reproduced from [4])...

Adriamycin (doxorubicin) Cyclophosphamide Oncovin (vincristine) Procarbazine Prednisone Repeat every 21 days BEACOPP (escalated) Bleomycin Etoposide... 

Available data suggest that the antitumor therapeutic response of older patients is optimal when exposure to appropriate chemotherapy is the same as for younger patients. For example, the treatment of non-HodgkiiVs lymphoma with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or etoposide, mitoxantrone, and prednimustine (VMP) is less effective in older patients when dose reductions are made (73, 74). Similarly, treatment of metastatic breast cancer in younger and older patients with the same dose intensity of doxorubicin-based chemotherapy resulted in similar outcomes as measured by time to progression of disease and overall survival (75). 

Endometrial Ewing s sarcomao" Gastric Head and neck,squamous cell Islet cell (pancreas) Kaposi s sarcoma Doxorubicin cisplatin + cyclophosphamide CAV Cyclophosphamide (or Ifosfamide) + doxorubicin (Adriamycin) + vincristine CF epirubidri + cisplatin 5-fluorouraci1 Cisplatin + S-fluorouracil Methotrexate Screptozotocin + S-fluorouracil Etoposide or interferon affa or vinblastine ABV doxorubicin (Adriamycin) + bteomycin + vincristine or vinblastine... 

Lung, small cell (oat cell) CAV cyclophosphamide + doxorubicin (Adriamycin) + vincristine EP etoposide + cisplatin... 

Five of thirty-two patients treated with the alternating drug regimen CAMBO-VIP (cyclophosphamide, doxorubicin, methotrexate, bleomycin, vincristine, etoposide, ifosfamide, and prednisolone) for non-Hodgkin s lymphoma developed blisters under the thickened skin of the palms and/or soles, followed by desquamation (28). 

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