Etoposide Hodgkin

For patients with myelodysplastic syndrome or AML as a secondary neoplasm, there are a number of key features characteristic of the leukemia. Alkylator-related secondary leukemias after Hodgkin s disease usually have a myelodysplastic prodrome and a monosomy 5 or monosomy 7. Secondary ANLL with the use of epipodophyllotoxin (etoposide) demonstrates mainly M4 or M5 morphology and exhibits translocations within the MLL gene with 1 lq23 chromosomal alterations.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. 

Etoposide is used for germinogenic tumors, ovarian, stomach, and lung cancer, Hodgkin s disease, and non-Hodgkin s lymphoma for both monotherapy and in combination therapy. Synonyms of this drug are vepesid and others. 

Etoposide Inhibits topoisomerase II Non-small cell and small cell lung cancer non-Hodgkin s lymphoma, gastric cancer Nausea, vomiting, hypotension Alopecia, myelosuppression... 

Hodgkin s disease (stages III and IV) Combination chemotherapy vinblastine, doxorubicin, dacarbazine, bleomycin Lomustine, etoposide, ifosfamide, interferon, mechlorethamine, vincristine, procarbazine, prednisone... 

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

Ohtsu T, Sasaki Y, Igarashi T, et al. Unexpected hepatotoxicities in patients with non-Hodgkin s lymphoma treated with irinotecan (CPT-11) and etoposide. Jpn J Clin Oncol 1998 28(8) 502-506. 

Bleomycin is a cytostatic drug that causes double-strand breaks in DNA. It has been used to treat Hodgkin s disease and a variety of solid cancers. It is often used in combination with other anticancer drugs, for example in the regimens known as ABVD (doxorubicin -r bleomycin -r vinblastine-r dacarbazine) and BEP (bleomycin-r etoposide -r cisplatin). It has also been injected intrapleu-rally in the management of malignant effusions. 

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). 

A 55-year-old man with chronic lymphocytic leukemia and rheumatoid arthritis took methotrexate for 4 years and developed a B cell non-Hodgkin s lymphoma in the shoulder and axillary lymph nodes he had Epstein-Barr viral antigens in the serum. After radiation and chemotherapy had failed, complete remission was achieved with a combination of rituximab and EPOCH (etoposide -I- prednisone -I- vincristine -I-cyclophosphamide + doxorubicin). 

Procarbazine is an alkylating agent that is used in the treatment of Hodgkin s disease in regimens such as MOPP (chlormethine (mechlorethamine), vincristine (Oncovin), procarbazine, and prednisolone) and BEACOPP (bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine, procarbazine, and prednisone) (1). It is also used to treat glioblastoma multiforme. 

In 37 patients with HIV-associated non-Hodgkin s lymphoma who were treated with a 96-hour continuous intravenous infusion of cyclophosphamide + doxorubicin + etoposide, severe (grade 3 or 4) mucositis occurred in eight of 12 patients who received concomitant saquinavir (600 mg tds) compared with three of 25 who did not receive saquinavir. Although the authors did not measure saquinavir plasma concentrations, they suggested that this finding may have been explained by inhibition of the metabolism of one or more of the cytotoxic drugs by saquinavir (17). 

Zulian GB, Selby P, Milan S, Nandi A, Gore M, Forgeson G, Perren TJ, McElwain TJ. High dose melpha-lan, BCNU and etoposide with autologous bone marrow transplantation for Hodgkin s disease. Br J Cancer 1989 59(4) 631-5. 

CDE cyclophosphamide, doxorubicin, and etoposide cHL classical Hodgkin s lymphoma... 

Etoposide is administered orally and parenterally in lung cancer (small cells), acute non-lymphoblastic leukaemia and also in Hodgkin s disease, whereas Teniposide is given by intravenous infusion in Hodgkin s disease, and certain forms of cerebral tumours and cancer of the urinary bladder. Etoposide and Teniposide have a cytostatic effect in the S-phase and G2-phase of the life cycle of the cell and differ from other podophyllin derivatives by not causing accumulation in the metaphase but prevent the cell from mitosis or destroy the cells that undergo mitosis. 

Etoposide is used primarily in treatment of testicular tumors in combination with bleomycin and cispiatin, and in combination with cispiatin and ifosfamide for small-cell carcinoma of the lung. It also is active against non-Hodgkin s lymphomas, acute nonlymphocytic leukemia, and Kaposi s sarcoma associated with AIDS. Etoposide has a favorable toxicity profile for dose escalation in that its primary acute toxicity is myelosuppression. In combination with ifosfamide and carboplatin, it is frequently used for high-dose chemotherapy in total doses of 1500 to 2000 mg/m. ... 

This potent anticancer drug is now widely used in chemotherapy in association with several other drugs (e.g., vinblastine, methotrexate, carboplatine, ifosfamide, or etoposide) in the treatment of Hodgkin s disease (9), of head and neck cancers (JO, 11), of disseminated germ cell tumors (12), and of poor-prognosis epidemic Kaposi s sarcoma (13) (for previous articles on the clinical use of BLM, see references listed in Refs. 9-13). 

The most important clinical use of vinblastine is with bleomycin and cisplatin (see below) in the curative therapy of metastatic testicular tumors, although it has been supplanted by etoposide or ifosfamide in this disease. It is a component of the standard curative AB VD regimen for Hodgkin s disease (adriamycin, bleomycin, vinblastine, and dacarbazine). It also is active in Kaposi s sarcoma, neuroblastoma, and histiocytosis X, and in carcinoma of the breast and choriocarcinoma. 

Bleomycin is highly effective against germ cell tumors of the testis and ovary. In testicular cancer it is curative when used with cisplatin and vinblastine or cisplatin and etoposide. It is used as a component of the standard ABVD regimen for Hodgkin s disease. Bleomycin also is given intrapleurally (60 U)for malignant pleural effusions. 

Nademanee A et al. A phase 1/2 trial of high-dose yttrium-90-ibritumomab tiuxetan in combination with high-dose etoposide and cyclophosphamide followed by autologous stem cell transplantation in patients with poor-risk or relapsed non-Hodgkin lymphoma. Blood 2005 106 2896-2902. 

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