Etoposide dosing challenges in a testicular cancer patient with hepatic impairment and drug-drug interactions–a case report

Oldenburg J, Berney DM, Bokemeyer C, Climent MA, Daugaard G, Gietema JA et al (2022) Testicular seminoma and non-seminoma: ESMO-EURACAN clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol 33(4):362–75

Article  CAS  PubMed  Google Scholar 

Beyer J, Collette L, Sauve N, Daugaard G, Feldman DR, Tandstad T et al (2021) Survival and new prognosticators in metastatic seminoma: results from the IGCCCG-update consortium. J Clin Oncol 39(14):1553–62

Article  CAS  PubMed  PubMed Central  Google Scholar 

European Association of Urology (EAU) (2025) EAU Guidelines on Testicular Cancer. European Association of Urology

Google Scholar 

Raggi D, Chakrabarti D, Cazzaniga W, Aslam R, Miletic M, Gilson C et al (2025) Management of Testicular Cancer. JCO Oncology Practice

Hande KR (1998) Etoposide: four decades of development of a topoisomerase II inhibitor. Eur J Cancer 34(10):1514–1521

Article  CAS  PubMed  Google Scholar 

Slevin ML (1991) The clinical pharmacology of etoposide. Cancer 67(S1):319–329

Article  CAS  PubMed  Google Scholar 

Creaven PJ (1982) The clinical pharmacology of VM26 and VP16-213. Cancer Chemother Pharmacol 7(2):133–140

CAS  PubMed  Google Scholar 

Relling MV, Nemec J, Schuetz EG, Schuetz JD, Gonzalez FJ, Korzekwa KR (1994) O-demethylation of epipodophyllotoxins is catalyzed by human cytochrome P450 3A4. Mol Pharmacol 45(2):352–358

Article  CAS  PubMed  Google Scholar 

Lovett BD, Strumberg D, Blair IA, Pang S, Burden DA, Megonigal MD et al (2001) Etoposide metabolites enhance DNA topoisomerase II cleavage near leukemia-associated MLL translocation breakpoints. Biochemistry 40(5):1159–70

Article  CAS  PubMed  Google Scholar 

Stremetzne S, Jaehde U, Kasper R, Beyer J, Siegert W, Schunack W (1997) Considerable plasma levels of a cytotoxic etoposide metabolite in patients undergoing high-dose chemotherapy. Eur J Cancer 33(6):978–979

Article  CAS  PubMed  Google Scholar 

Cai X, Woo MH, Edick MJ, Relling MV (1999) Simultaneous quantitation of etoposide and its catechol metabolite in human plasma using high-performance liquid chromatography with electrochemical detection. J Chromatogr B Biomed Sci 728(2):241–250

Article  CAS  Google Scholar 

Hikma Pharmaceuticals (2024) Summary of Product Characteristics Etoposide

Jouinot A, Royer B, Chatelut E, Moeung S, Assie G, Thomas-Schoemann A et al (2018) Pharmacokinetic interaction between mitotane and etoposide in adrenal carcinoma: a pilot study. Endocr Connect 7(12):1409–14

Article  CAS  PubMed  PubMed Central  Google Scholar 

Yong WP, Desai AA, Innocenti F, Ramirez J, Shepard D, Kobayashi K et al (2007) Pharmacokinetic modulation of oral etoposide by ketoconazole in patients with advanced cancer. Cancer Chemother Pharmacol 60(6):811–9

Article  CAS  PubMed  Google Scholar 

Lum BL, Kaubisch S, Yahanda AM, Adler KM, Jew L, Ehsan MN et al (1992) Alteration of etoposide pharmacokinetics and pharmacodynamics by cyclosporine in a phase I trial to modulate multidrug resistance. J Clin Oncol 10(10):1635–42

Article  CAS  PubMed  Google Scholar 

Stewart CF, Arbuck SG, Fleming RA, Evans WE (1990) Changes in the clearance of total and unbound etoposide in patients with liver dysfunction. J Clin Oncol 8(11):1874–1879

Article  CAS  PubMed  Google Scholar 

Stewart CF (1994) Use of Etoposide in patients with organ dysfunction: Pharmacokinetic and pharmacodynamic considerations. Cancer Chemother Pharmacol 34(Suppl):S76–83

Article  PubMed  Google Scholar 

Stewart CF, Arbuck SG, Fleming RA, Evans WE (1991) Relation of systemic exposure to unbound etoposide and hematologic toxicity. Clin Pharmacol Ther 50(4):385–393

Article  CAS  PubMed  Google Scholar 

Giraud EL, de Lijster B, Krens SD, Desar IME, Boerrigter E, van Erp NP (2023) Dose recommendations for anticancer drugs in patients with renal or hepatic impairment: an update. Lancet Oncol 24(6):e229

Article  CAS  PubMed  Google Scholar 

UpToDate Lexidrug Interactions: UpToDate Inc.; [6 February 2025]. Available from: https://online.lexi.com/lco/action/interact

Vertex Pharmaceuticals (2022) (Ireland) Limited. Summary of Product Characteristics Kalydeco

Pfizer (2017) Summary of Product Characteristics Zythromax

Strik J, de Jong LAW, Sijm J, Desar IME, van Erp NP (2024) Effect of aprepitant on etoposide pharmacokinetics in patients with testicular cancer: a pharmacokinetic study to determine the absence of a clinically relevant interaction. Clin Pharmacol Ther 115(1):135–8

Article  CAS  PubMed  Google Scholar 

Hande K, Messenger M, Wagner J, Krozely M, Kaul S (1999) Inter- and intrapatient variability in etoposide kinetics with oral and intravenous drug administration. Clin Cancer Res 5(10):2742–2747

CAS  PubMed  Google Scholar 

Thomas HD, Porter DJ, Bartelink I, Nobbs JR, Cole M, Elliott S et al (2002) Randomized cross-over clinical trial to study potential pharmacokinetic interactions between cisplatin or carboplatin and etoposide. Br J Clin Pharmacol 53(1):83–91

Article  CAS  PubMed  PubMed Central  Google Scholar 

Stewart CF, Pieper JA, Arbuck SG, Evans WE (1989) Altered protein binding of etoposide in patients with cancer. Clin Pharmacol Ther 45(1):49–55

Article  CAS  PubMed  Google Scholar 

van de Poll ME, Relling MV, Schuetz EG, Harrison PL, Hughes W, Flynn PM (2001) The effect of atovaquone on etoposide pharmacokinetics in children with acute lymphoblastic leukemia. Cancer Chemother Pharmacol 47(6):467–72

Article  PubMed  Google Scholar 

Bisogno G, Cowie F, Boddy A, Thomas HD, Dick G, Pinkerton CR (1998) High-dose cyclosporin with etoposide–toxicity and pharmacokinetic interaction in children with solid tumours. Br J Cancer 77(12):2304–2309

Article  CAS  PubMed  PubMed Central  Google Scholar 

Joel SP, Shah R, Clark PI, Slevin ML (1996) Predicting etoposide toxicity: relationship to organ function and protein binding. J Clin Oncol 14(1):257–267

Article  CAS  PubMed  Google Scholar 

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