Etoposide is a chemotherapy drug used to treat small cell lung cancer, ovarian cancer, testicular cancer, leukaemiaand lymphoma.

This information should ideally be read with our general information about chemotherapy and the type of cancer you have.

You will be given etoposide in the chemotherapy day unit or during a stay in hospital. A chemotherapy nurse will give it to you. Etoposide can be given in combination with other chemotherapy drugs. During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.

Before or on the day of treatment, a nurse or a person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.

You will also see a doctor or nurse before you have chemotherapy. They will ask you how you have been feeling. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.

Your nurse will give you anti-sickness drugs before you start. Etoposide is then given in one of the following ways:

• through a short thin tube the nurse puts into a vein in your arm or hand (cannula)

• through a fine tube that goes under the skin of your chest and into a nearby vein (central line)

• through a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line)

• as capsules.

If you don’t have the drug as capsules, your nurse will give you etoposide as a drip (infusion) into your cannula or line. They usually run the drip through a pump, which gives you the treatment over a period of up to three and a half hours.

Some people might have side effects while they are having the chemotherapy:

Allergic reaction

Some people have an allergic reaction to etoposide. This can happen when it is given, or for up to an hour afterwards. You will be given drugs before the infusion to reduce the chance of a reaction happening. A reaction is usually mild but, rarely, it can be more severe. If you have a reaction, the nurses can usually treat this by slowing or stopping the drip. You will have the rest of your treatments given at a slower rate.

You will be monitored closely during treatment. Tell your nurse or doctor if you feel unwell or have any of the following symptoms:

• flu-like symptoms, such as headache, feeling flushed, having a fever, chills or dizziness

• red, warm and itchy bumps on the skin (like nettle rash)

• a feeling of swelling in the lips, tongue or throat

• breathlessness, wheezing, a cough or sudden difficulty breathing

• tight chest or chest pain.

The drug leaks outside the vein

If this happens it can damage the tissue around the vein. This is called extravasation. Extravasation is not common but if it happens it is important that it is dealt with quickly. Tell your nurse straight away if you have any stinging, pain, redness or swelling around the vein.

If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the number they gave you.

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur. The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body.

Etoposide belongs to a class of chemotherapy drugs called plant alkaloids. Plant alkaloids are made from plants. The vinca alkaloids are made from the periwinkle plant (catharanthus rosea). The taxanes are made from the bark of the Pacific Yew tree (taxus). The vinca alkaloids and taxanes are also known as antimicrotubule agents. The podophyllotoxins are derived from the May apple plant. Camptothecan analogs are derived from the Asian "Happy Tree" (Camptotheca acuminata). Podophyllotoxins and camptothecan analogs are also known as topoisomerase inhibitors. The plant alkaloids are cell-cycle specific. This means they attack the cells during various phases of division.

• Vinca alkaloids: Vincristine, Vinblastine and Vinorelbine

• Taxanes: Paclitaxel and Docetaxel

• Podophyllotoxins: Etoposide and Tenisopide

• Camptothecan analogs: Irinotecan and Topotecan

Topoisomerase inhibitors (such as etoposide) are drugs that interfere with the action of topoisomerase enzymes (topoisomerase I and II). Topoisomerase enzymes control the manipulation of the structure of DNA necessary for replication.

• Topoisomerase I inhibitors: Ironotecan, topotecan

• Topoisomerase II inhibitors: Amsacrine, etoposide, etoposide phosphate, teniposide

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Take your etoposide capsules exactly as explained to you. This is important to make sure they work as well as possible for you.

Swallow the capsules whole on an empty stomach. If you are sick just after taking the capsules, contact the hospital. You may need to take another dose. If you forget to take a capsule, do not take a double dose. Keep to your regular schedule and let your doctor or nurse know.

Other things to remember about your capsules:

• Keep them in the original package at room temperature and away from heat and direct sunlight.

• Keep them safe and out of the reach of children.

• If your treatment is stopped, return any remaining capsules to the pharmacist.

You have blood tests before starting treatment and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

We explain the most common side effects of this treatment here. We also include some less common side effects.

You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we haven’t listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.

If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:

• your temperature goes over 37.5°C (99.5F)

• you suddenly feel unwell, even with a normal temperature

• you have symptoms of an infection.

Symptoms of an infection include:

• feeling shivery

• a sore throat

• a cough

• diarrhoea

• needing to pass urine often.

It is important to follow any specific advice your cancer treatment team gives you.

The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cell count is low, your doctor may delay your treatment for a short time.

Bruising and bleeding

Chemotherapy can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor or nurse if you have any bruising or bleeding that you can’t explain. This includes:

• nosebleeds

• bleeding gums

• tiny red or purple spots on the skin that may look like a rash.

Some people may need a drip to give them extra platelets. This is called a platelet transfusion.

Anaemia (low number of red blood cells)

Chemotherapy can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Feeling sick

You may feel sick in the first few days after chemotherapy. Your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.

Loss of appetite

This treatment can affect your appetite. Do not worry if you don’t eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.

Diarrhoea

If you have diarrhoea, contact the hospital for advice. Try to drink at least two litres (three and a half pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Constipation

This treatment can cause constipation. Here are some tips that may help:

• Drink at least two litres (three and a half pints) of fluids each day.

• Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.

• Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.

Feeling tired

Feeling tired is a common side effect. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.

Sore mouth

You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth is sore:

• tell your nurse or doctor – they can give you a mouthwash or medicines to help

• try to drink plenty of fluids

• avoid alcohol, tobacco, and foods that irritate your mouth.

Hair loss

Your hair will get thinner or you may lose all the hair from your head. You may also lose your eyelashes, eyebrows or other body hair. Hair loss usually starts after your first or second treatment.

Your nurse can talk to you about ways to cope with hair loss. There are ways to cover up hair loss if you want to. It is important to cover your head to protect your scalp when you are out in the sun.

Hair loss is almost always temporary and your hair will usually grow back after treatment ends.

Skin changes

Etoposide may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. Etoposide can cause a rash, which may be itchy. Your skin may darken. It will return to its normal colour after you finish treatment. If you’ve had radiotherapy (either recently or in the past), the area that was treated may become red or sore.

Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when your treatment finishes.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.

Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug or delay treatment for a short time. The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.

Changes in the way your liver or kidneys work

This treatment can affect how your kidneys and liver work. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your kidneys and liver are working.

Effects on the lungs

This treatment can cause changes to the lungs. Tell your doctor if you develop:

• a cough

• wheezing

• a fever (high temperature)

• breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

Effects on the nervous system

Etoposide can affect the nervous system. You may feel anxious or restless, have problems sleeping or experience mood changes. Some people may feel drowsy or confused. If you notice any of these symptoms, tell your doctor or nurse straight away. It is important not to drive or operate machinery if you notice these effects.

Eye problems

Rarely, etoposide may affect your vision. If you have eye pain or notice any change in your vision, always tell your doctor or nurse.

Second cancer

Rarely, etoposide can increase the risk of developing a second cancer, usually leukaemia, years later. But the benefits of treatment usually far outweigh this risk. Your doctor can talk to you about this.

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

• pain, redness or swelling in a leg or arm

• breathlessness

• chest pain.

If you have any of these symptoms, contact a doctor straight away.

A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

Other medicines

Some medicines can affect chemotherapy or be harmful when you are having it. This includes medicines you can buy in a shop or chemist. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.

Fertility

Some cancer drugs can affect whether you can get pregnant or father a child. If you are worried about this, it is important to talk with your doctor before you start treatment.

Contraception

Your doctor will advise you not to get pregnant or father a child while having this treatment. The drugs may harm the developing baby. It is important to use effective contraception during your treatment.

Sex

If you have sex in the first few days after chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluids.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. This is because the drugs could be passed to the baby through breast milk.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.

• Apply warm compresses if you have any pain, redness or swelling at the IV site, and notify your doctor.

• Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.

• You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.

• Wash your hands often.

• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.

• Use an electric razor and a soft toothbrush to minimize bleeding.

• Avoid contact sports or activities that could cause injury.

• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.

• Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.

• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.

• Get plenty of rest.

• Maintain good nutrition.

• If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

• Fever of 100.4° F (38° C) or higher, chills (possible signs of infection).

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

• Nausea (interferes with ability to eat and unrelieved with prescribed medication)

• Vomiting (vomiting more than 4-5 times in a 24 hour period)

• Diarrhea (4-6 episodes in a 24-hour period)

• Unusual bleeding or bruising

• Black or tarry stools, or blood in your stools or urine

• Extreme fatigue (unable to carry on self-care activities)

• Mouth sores (painful redness, swelling or ulcers)

• Swelling, redness and/or pain in one leg or arm and not the other

• Numbness or tingling in your fingers or toes

• Yellowing of the skin or eyes

• Pain, redness or swelling at the IV site

Always inform your health care provider if you experience any unusual symptoms.