Prolonged administration of low-daily-dose etoposide: a superior dosing schedule?
Despite the clinical use of etoposide for about 20 years, the best dose and schedule of administration remains unknown. The schedule dependency for small-cell lung cancer (SCLC) has been unequivocally demonstrated, and it is probably similar for other sensitive neoplasms (for example, lymphoma, germ cell tumors). A more extended schedule of administration (i.e., 14-21 days) may be more effective than the standard 3- to 5-day schedule. Plasma levels in reference to dose, schedule, and tumor responsiveness have been evaluated in several studies. These data suggest that high peak levels (i.e., > 5-10 micrograms/ml) are most often associated with more severe myelosuppression than are lower peak plasma levels (i.e., 1-3 micrograms/ml). In SCLC patients the response rates and survival observed following the administration of low daily etoposide doses for 14-21 days are similar to the results achieved with standard doses given for 3-5 days. These data as well as other studies suggest that giving low daily doses of etoposide on a prolonged schedule is superior. Randomized comparisons are necessary for an unequivocal confirmation of these observations.
Greco
F A
FA
Sarah Cannon (Minnie Pearl) Cancer Center, Centennial Medical Center, Nashville, TN 37203.
Hainsworth
J D
JD
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018288:Carcinoma, Small Cell / Q000188:drug therapy*; D017322:Clinical Trials, Phase II as Topic; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage* / Q000627:therapeutic use / Q000633:toxicity; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D009369:Neoplasms / Q000188:drug therapy*; D010865:Pilot Projects; D013997:Time Factors
D005047:Etoposide