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Treatment Name: Cisplatin + Etoposide

Cisplatin + Etoposide is a Chemotherapy Regimen for Lung Cancer, Small Cell Lung Cancer (SCLC)

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

Goals of therapy:
Cisplatin + Etoposide is commonly given with the goal of cure, however small cell lung cancer frequently relapses, and further therapy may be offered if this occurs.

Schedule

  • Cisplatin intravenous infusion (I.V.), usually given over 1 - 2 hours on Days 1
  • Etoposide I.V. infusion, usually given over one hour on Days 1, 2, and 3

Typically, these two drugs are given one after the other on the same day.

Cisplatin + Etoposide are usually given at an outpatient infusion center, allowing the person to go home afterwards. Radiation may be given before and/or after each daily dose. On rare occasion, this may be given in the hospital for the first cycle if someone is newly diagnosed. Often, the first day of treatment can take upwards of five hours.

Cisplatin + Etoposide are repeated every 21 days. This is known as one Cycle. Each cycle may be repeated 4 to 6 times. After recovering from these chemotherapy cycles regular follow-up with an oncologist will determine any further therapy.

Click here for common starting doses

In addition to chemotherapy, radiation therapy may be recommended by your doctor

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 side effects with Cisplatin + Etoposide are shown here. Side effects sometimes have percentage ranges [example: vomiting 60-70%] because they differed between clinical studies.

  • Anemia [low red blood cell count] (85%)
  • Vomiting (60 - 70%)
  • Weight loss (58 - 68%)
  • Increased bleeding risk [low platelet count] (65%)
  • Esophagus inflammation (37 - 56%)
  • Fever (38 - 45%)
  • Infection (20 - 27%)

Side effect videos Side Effect Videos
AnemiaAnemiaNausea and VomitingNausea and VomitingNeutropenic FeverNeutropenic FeverFatigue Fatigue

Monitoring

How often is monitoring needed?
Labs (blood tests) are usually checked before treatment on Day 1 of each cycle. 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 is done before treatment, then usually after four to six cycles of chemotherapy. Imaging may include: CXR (chest X-ray, CT-scan (computed tomography), and MRI (magnetic resonance imaging).

How might blood test results/imaging affect treatment? 
Depending upon the blood test results before each cycle, your doctor may adjust drug doses, or delay, or switch 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
  • 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 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. Turrisi AT, Kyungmann K, Blum R, et al. Twice-Daily Compared With Once-Daily Thoracic Radiotherapy In Limited Small-Cell Lung Cancer Treated Concurrently With Cisplatin And Etoposide. N Engl J Med 1999;340(4):265-71.

2. Saito H, Takada Y, Ichinose Y, et al. Phase II Study of Etoposide and Cisplatin With Concurrent Twice-Daily Thoracic Radiotherapy Followed by Irinotecan and Cisplatin in Patients With Limited-Disease Small-Cell Lung Cancer: West Japan Thoracic Oncology Group 9902. J Clin Oncol 2006;24:5247-5252.

Created: September 20, 2015 Updated: September 10, 2018

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.

Clinical Studies

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

1. Turrisi AT, Kyungmann K, Blum R, et al. Twice-Daily Compared With Once-Daily Thoracic Radiotherapy In Limited Small-Cell Lung Cancer Treated Concurrently With Cisplatin And Etoposide. N Engl J Med 1999;340(4):265-71.

2. Saito H, Takada Y, Ichinose Y, et al. Phase II Study of Etoposide and Cisplatin With Concurrent Twice-Daily Thoracic Radiotherapy Followed by Irinotecan and Cisplatin in Patients With Limited-Disease Small-Cell Lung Cancer: West Japan Thoracic Oncology Group 9902. J Clin Oncol 2006;24:5247-5252.

Common starting doses

  • Cisplatin 60 - 80 mg/m2 IV over one to two hours on Day 1
  • Etoposide 100 - 120 mg/m2 IV over one hour on Days 1, 2, and 3
  • Radiation therapy, once to twice daily as determined by physician

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

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.