Etoposide

Etoposide, sold under the brand name Vepesid among others, is a chemotherapy medication used for the treatments of a number of types of cancer including testicular cancer, lung cancer, lymphoma, leukemia, neuroblastoma, and ovarian cancer. It is also used for hemophagocytic lymphohistiocytosis. It is used by mouth or injection into a vein.
Side effects are very common. They can include low blood cell counts, vomiting, loss of appetite, diarrhea, hair loss, and fever. Other severe side effects include allergic reactions and low blood pressure. Use during pregnancy will likely harm the baby. Etoposide is in the topoisomerase inhibitor family of medication. It is believed to work by damaging DNA.
Etoposide was approved for medical use in the United States in 1983. It is on the World Health Organization's List of Essential Medicines.
Medical uses.
Etoposide is used as a form of chemotherapy for cancers such as Kaposi’s sarcoma, Ewing's sarcoma, lung cancer, testicular cancer, lymphoma, nonlymphocytic leukemia, and glioblastoma multiforme. It is often given in combination with other drugs (such as bleomycin in treating testicular cancer). It is also sometimes used in a conditioning regimen prior to a bone marrow or blood stem cell transplant.
Administration.
It is given intravenously (IV) or orally in capsule or tablet form. If the drug is given IV, it must be done slowly over a 30- to 60-minute period because it can lower blood pressure as it is being administered. Blood pressure is checked often during infusing, with the speed of administration adjusted accordingly.
Side effects.
Common are:
Less common are:
When given with warfarin, it may cause bleeding.
Pharmacology.
Mechanism of action.
Etoposide forms a ternary complex with DNA and the topoisomerase II enzyme (which aids in relaxing negative or positive supercoils in DNA), prevents re-ligation of the DNA strands, and by doing so causes DNA strands to break. Cancer cells rely on this enzyme more than healthy cells, since they divide more rapidly. Therefore, this causes errors in DNA synthesis and promotes apoptosis of the cancer cell.
Chemistry.
Etoposide is a semisynthetic derivative of podophyllotoxin from the rhizome of the wild mandrake ("Podophyllum peltatum"). More specifically, it is a glycoside of podophyllotoxin with a -glucose derivative. It is chemically similar to the anti-cancer drug teniposide, being distinguished only by a methyl group where teniposide has a thienyl. Both these compounds have been developed with the aim of creating less toxic derivatives of podophyllotoxin.
The substance is a white to yellow-brown, crystalline powder. It is soluble in organic solvents.
It is used in form of its salt etoposide phosphate.
History.
Etoposide was first synthesized in 1966 and U.S. Food and Drug Administration approval was granted in 1983.
The nickname VP-16 likely comes from a compounding of the last name of one of the chemists who performed early work on the drug (von Wartburg) and podophyllotoxin. Another scientist who was integral in the development of podophyllotoxin-based chemotherapeutics was the medical pharmacologist Hartmann F. Stähelin.