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Treatment Name: Cisplatin + Etoposide

Cisplatin + Etoposide is a Chemotherapy Regimen for Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)

How does cisplatin + etoposide work?
Both cisplatin and etoposide are designed to kill lung cancer cells by damaging DNA and preventing the lung cancer cells from dividing into new cells.

Goals of therapy:
Cisplatin + etoposide is given to shrink tumors and improve symptoms of lung cancer. If the disease is not metastatic (spread to areas of the body outside the lungs), cisplatin + etoposide may be given to patients as first-line adjuvant or neoadjuvant therapy with the goal of cure. If the disease is metastatic, cisplatin + etoposide may not be curative, but may still prolong life and relieve certain symptoms.

Durvalumab (Imfinzi) may be given to certain patients with Stage 3 unresectable non-small cell lung cancer (NSCLC) after they complete chemotherapy plus radiation. Durvalumab is given with the goal of preventing the cancer from growing or spreading and the goal of increasing lifespan.

Schedule

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  • Cisplatin intravenous (I.V.) infusion over 60 minutes on Day 1
  • Etoposide I.V. infusion over 60 minutes on Days 1, 2, and 3

Estimated total infusion time for this treatment:

  • Up to 3 hours for Day 1 of each Cycle; as short as one hour 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 intravenous (I.V.) fluids, such as hydration, may add more time

Cisplatin + 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.

Cisplatin + etoposide is repeated every 21 days. This is known as one Cycle. If used as adjuvant or neoadjuvant therapy, cisplatin + etoposide is typically is given for 3 to 6 cycles. If given for metastatic disease, treatment is continued until disease progression or until unacceptable side effects occur. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.

Click here for the common cisplatin + etoposide starting doses.

Side Effects

In a multi-drug regimen, each medication has unique drug 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 serious (grade 3 or 4) side effects of cisplatin + etoposide are shown here:

Side effect videos Side Effect Videos
Hair LossHair LossNausea and VomitingNausea and VomitingAnemiaAnemiaNeutropenic FeverNeutropenic FeverBleedingBleeding

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before each treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), blood magnesium level, plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment, during treatment if there are concerns for disease progression or side effects, or at the end of treatment to determine response to treatment. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue cisplatin + etoposide as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.

ChemoExperts Tips

  • Cisplatin can possibly damage the kidneys. Any damage is usually reversible. Your doctor will monitor your blood for signs of any kidney damage and may give intravenous fluid to help protect your kidneys before or after cisplatin therapy. If you feel dehydrated, tell your doctor
  • If you have locally advanced, stage 3 unresectable (cancer that cannot be removed with surgery) non-small cell lung cancer and also complete at least 2 cycles of platinum-containing chemotherapy (medications such as cisplatin or cisplatin) given at the same time as radiation, you may qualify for a medication known as durvalumab (Imfinzi) when chemoradiotherapy is complete. Roughly 25% of patients with non-small cell lung cancer have stage 3 disease at diagnosis and a proportion of these will have unresectable disease.
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for NSCLC. 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 Cisplatin + Etoposide, 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 Cisplatin + Etoposide. Depending upon your income, they may be able to help cover the cost of:

  • Cisplatin
  • 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 Cisplatin + Etoposide 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 Cisplatin + Etoposide

Individual Drug Label Information

Cisplatin (Platinol®)

  • Cisplatin is an intravenous (I.V.) infusion that is typically given over one to two hours
  • Cumulative toxicity to kidneys from cisplatin can be severe 
  • Other toxicities from multiple doses are:  low blood counts, nausea, vomiting, and hearing loss
  • Dosage adjustments may be required for poor kidney function or bone marrow toxicity (low blood counts) 
  • Cisplatin is hazardous to a human fetus; women should avoid pregnancy while on this drug 
  • Women should not breast-feed while on cisplatin; it has been reported to be in human milk 
  • Patients on anticonvulsant drugs may have decreased levels while on cisplatin 
General Cisplatin (Platinol) Side Effects 
  • Kidney problems (nephrotoxicity), especially in elderly patients. 
  • Nausea and vomiting, both acute (within first 24 hours) and delayed (two to five days after infusion) 
  • Diarrhea 
  • Low blood cell counts (myelotoxicity, acute leukemia)
  • Hearing problems- ringing ears.  All patients should have a baseline hearing test done.  All children should have hearing test done before each dose and for several years after therapy is complete 
  • Low blood electrolytes:  magnesium, potassium, calcium, sodium, and phosphate
  • Nerve pain 
  • Vision problems; improvement and/or complete recovery usually occurs after stopping therapy 
  • Liver toxicity; recovery usually occurs after stopping therapy 
  • Click on the cisplatin (Platinol) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue PainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

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) Cardenal F, Lopez-Cabrerizo MP, Anton A, et al. Randomized phase III study of gemcitabine-cisplatin versus etoposide-cisplatin in the treatment of locally advanced or metastatic non-small cell lung cancer. J Clin Oncol. 1999;17:12-18.

2) Arriagada R, Bergman B, Dunant A, et al. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med. 2004;350:351-360.

3) Antonia SJ, Villegas A, Daniel D, et al. Overall survival with durvalumab after chemoradiotherapy in stage III NSCLC. N Engl J Med 2018;379:2342-2350. 

Created: March 12, 2019 Updated: May 2, 2019

What is Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)?

What is Non-Small Cell Lung Cancer?
A disease of the tissue found in the lung.  Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Known causes include smoking and exposure to environmental toxins.  The stage of NSCLC can vary at diagnosis and throughout treatment.  Stages include stage I, II, III, and IV.  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.

Common Cisplatin + Etoposide starting doses

  • Cisplatin 100 mg/m2 intravenous (I.V.) infusion over 60 minutes on Day 1
  • Etoposide 100 mg/m2 I.V. infusion over 60 minutes on Days 1, 2, and 3
  • Cisplatin + etoposide is repeated every 21 days. This is known as one Cycle. If used as adjuvant or neoadjuvant therapy, cisplatin + etoposide is typically is given for 3 to 6 cycles. If given for metastatic disease, treatment is continued until disease progression or until unacceptable side effects occur. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability.

What is Adjuvant Chemotherapy?

Adjuvant chemotherapy is given after surgical removal of the primary cancer tumor. The goal of adjuvant chemotherapy is to target microscopic cancer cells that may remain after surgical removal of the primary tumor to help prevent recurrence of the disease.

What is Neoadjuvant Chemotherapy?

Neoadjuvant chemotherapy is given before surgery or radiation with the goal of shrinking the primary cancer tumor to make either surgical removal of the tumor or radiation of the tumor easier.

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 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, 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.