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Treatment Name: Carboplatin + Etoposide (Carbo/Etop)

Carboplatin + Etoposide (Carbo/Etop) is a Chemotherapy Regimen for Lung Cancer, Small Cell Lung Cancer (SCLC)

How does carboplatin plus etoposide work?
Each of the medications in carboplatin + etoposide are designed to target and kill rapidly dividing lung cancer cells.

Goals of therapy:
Carboplatin + etoposide is given to shrink tumors and alleviate symptoms of lung cancer. If the stage of the cancer is limited stage, it can be given along with radiation for the goal of cure. However, if the stage of the cancer is extensive stage or if you have received prior therapy and the cancer has relapsed (returned), it is not commonly given with the goal of cure.

Schedule

  • Carboplatin intravenous (I.V.) infusion over 30 minutes on Day 1
  • Etoposide I.V. infusion over one hour on Days 1 through 3

Estimated total infusion time for this treatment:

  • Up to three hours for Day 1 of each cycle; as short as two hours for Days 2 and 3 of each cycle
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and I.V. fluids, such as hydration, may add more time

Carboplatin + etoposide is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, it may be given in the hospital if someone is too sick.

Carboplatin + etoposide is repeated every 21 or 28 days. This is known as one Cycle. Each cycle may be repeated up to six times, depending upon the stage of the disease. Duration of therapy may last up to six months, depending upon response, tolerability, and number of cycles prescribed.

Click here for the common carboplatin and etoposide starting doses.

Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported carboplatin plus etoposide side effects are shown here. Side effects sometimes have percentage ranges [example 72 – 95%] because they differed between clinical studies:

On average, 3% of patients discontinue treatment due to unacceptable side effects.

Hair loss from carboplatin plus etoposide is often noticeable. A wig or hair piece may be desired to camouflage the absence of hair until it grows back.

The present day incidence of nausea or vomiting may be lower than percentages reported in the original clinical studies (1999-2001) because newer medications designed to prevent nausea and vomiting are now available.

Side effect videos Side Effect Videos
AnemiaAnemiaHair LossHair LossBleedingBleedingPainPainNausea and VomitingNausea and VomitingDiarrheaDiarrheaNeutropenic FeverNeutropenic FeverConstipationConstipationFatigue Fatigue Blood ClotsBlood Clots

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before treatment and periodically in-between treatments. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment and after every 2 or 3 cycles until treatment is completed. Imaging may include: X-rays, magnetic resonance imaging (MRI), or computerized tomography (CT) scans.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue carboplatin + etoposide as planned, decrease the dose of carboplatin or etoposide, or recommend switching therapy.

ChemoExperts Tips

  • In some instances, if your white blood cells drop too low this is known as "neutropenia"...you may need to receive filgrastim (Neupogen®) or pegfilgrastim (Neulasta®) after chemotherapy to stimulate production of white blood cells and avoid periods of neutropenia
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for small cell lung cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Carboplatin + Etoposide (Carbo/Etop), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Carboplatin + Etoposide (Carbo/Etop). Depending upon your income, they may be able to help cover the cost of:

  • Carboplatin
  • Etoposide

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Carboplatin + Etoposide (Carbo/Etop) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Carboplatin + Etoposide (Carbo/Etop)

Individual Drug Label Information

Carboplatin (Paraplatin®)

  • Carboplatin is an intravenous infusion 
  • This medication is dosed based on your kidney function. If your kidney function improves or worsens during therapy, your dose may need to be adjusted
  • This drug should not be used during pregnancy, it may cause fetal harm
General Carboplatin (Paraplatin) Side Effects:  
  • Low red blood cells, low white blood cells, and most commonly, low platelets can be occur
  • Nausea and vomiting is common but can be prevented by taking certain pre-medications
  • Hair loss
  • Constipation and/or diarrhea
  • Pain
  • Allergic reactions to carboplatin can occur. These typically are not seen until after the 6th dose of carboplatin is given 
  • Can cause liver damage at high doses 
  • May cause kidney damage or hearing loss if combined with other medications that also cause these side effects 
  • Click on the carboplatin (Paraplatin) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossBleedingBleedingConstipationConstipationPainPainAnemiaAnemia

See DailyMed package insert.

Etoposide (VP-16)

  • Etoposide is an intravenous (I.V.) infusion that is typically given over 30-60 minutes or in some instances, as a continuous infusion
  • Etoposide interacts with grapefruit juice and can cause increased exposure to etoposide if taken together
  • Dosage adjustments may be required for decreased kidney or liver function
General Etoposide (VP-16) Side Effects
  • Often causes temporary hair loss, which is usually reversible after stopping etoposide therapy
  • Gastrointestinal side effects such as diarrhea, mouth sores, nausea and upset stomach can be common
  • Although rare, it has been linked to the development of acute leukemia (2-12%) and typically occurs 2-3 years after therapy
  • May cause low blood counts (white blood cells, red blood cells, and platelets)
  • Click on the etoposide (VP-16) package insert below for reported side effects and potential drug Interactions

Side Effect Videos
DiarrheaDiarrheaHair LossHair LossFatigue Fatigue BleedingBleedingAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

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References

1) Skarlos DV, Samantas E, Briassoulis E, et al. Randomized comparison of early versus late hyperfractionated thoracic irradiation concurrently with chemotherapy in limited disease small-cell lung cancer: a randomized phase II study of the Hellenic Cooperative Oncology Group (HeCOG). Ann Oncol. 2001;12:1231-1238.

2) Okamoto H, Watanabe K, Nishiwaki Y, et al. Phase II study of area under the plasma-concentration-versus-time curve–based carboplatin plus standard-dose intravenous etoposide in elderly patients with small-cell lung cancer. J Clin Oncol. 1999;17:3540-3545.

Created: December 29, 2016 Updated: January 2, 2017

What is Lung Cancer, Small Cell Lung Cancer (SCLC)?

What is Small Cell Lung Cancer?
A disease of the tissue found in the lung. Small cell lung cancer (SCLC) is the second most common type of lung cancer, occuring in 10% to 15% of cases. It occurs most commonly in smokers and because it spreads rapidly, up to 70% of patients have metastatic disease at diagnosis. SCLC responds very well to chemotherapy and radiation because of its rapid-type growth.

The stage of SCLC can vary at diagnosis and throughout treatment. Most doctors classify patients two ways: Limited stage or Extensive stage.

  • Limited stage SCLC generally means it is found only in one lung, in lymph nodes on one side of the chest, and can be treated with radiation in a single field, chemotherapy, or a combination of these. About one-third of patients with small cell lung cancer are diagnosed with limited stage.
  • Extensive stage is when tumors are found in both lungs and distant organs. This is usually treated with only chemotherapy (and NO radiation) because the cancer is widespread and whole body radiation would be too toxic. Two-thrids of patients with small cell lung cancer are diagnosed with extensive stage

Doctors may also use the Tumor, Node, Metastasis (TNM) staging. Once TNM categories have been decided by the doctor, stage grouping is used: Stages are: 0, 1, 2, 3, or 4  (0, I, II, III, IV), with some sub-grouping using letters A and B. The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is Limited Stage?

Limited stage SCLC generally means it is found only in one lung, in lymph nodes on one side of the chest, and can be treated with radiation in a single field, chemotherapy, or a combination of radiation and chemotherapy. About one-third of patients with small cell lung cancer are diagnosed with limited stage.

What does Extensive Stage mean?

Extensive stage is when tumors are found in both lungs and other distant organs. This is usually treated only with chemotherapy (and NO radiation) because the cancer is widespread and whole body radiation would be too toxic. Two-thirds of patients with small cell lung cancer are diagnosed with extensive stage.

What does Cure mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, doctors use the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

Common Carboplatin and Etoposide Starting Doses

  • Carboplatin AUC 5 or 6 intravenous (I.V.) infusion over 30 minutes on Day 1
  • Etoposide 100 mg/m2 I.V. infusion over one hour on Days 1, 2, and 3

Clinical Studies

If you are interested in reading the clinical trials results, please click on references below:

1) Skarlos DV, Samantas E, Briassoulis E, et al. Randomized comparison of early versus late hyperfractionated thoracic irradiation concurrently with chemotherapy in limited disease small-cell lung cancer: a randomized phase II study of the Hellenic Cooperative Oncology Group (HeCOG). Ann Oncol. 2001;12:1231-1238.

2) Okamoto H, Watanabe K, Nishiwaki Y, et al. Phase II study of area under the plasma-concentration-versus-time curve–based carboplatin plus standard-dose intravenous etoposide in elderly patients with small-cell lung cancer. J Clin Oncol. 1999;17:3540-3545.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium

What is Neutropenia?

An abnormally low amount of a certain type of white blood cells, called neutrophils, in the blood. These neutrophils help the body body fight infections caused by bacteria and viruses.

Many chemotherapy drugs temporarily damage bone marrow where white blood cells are created, resulting in neutropenia. Please watch our video on neutropenic fever to learn more.