Chemotherapy involves using medications to target and eliminate rapidly dividing cancer cells throughout the body. Among various regimens, the combination of cisplatin and etoposide is a common and effective treatment approach. These two agents work together to combat different types of malignancies. This combination aims to improve outcomes for patients facing various forms of cancer.
Understanding Cisplatin and Etoposide
Cisplatin is a platinum-based chemotherapy drug that functions by forming cross-links within the DNA of cancer cells. These cross-links interfere with the normal DNA replication and transcription processes, thereby preventing the cancer cells from dividing and growing. The damage induced by cisplatin ultimately triggers programmed cell death, or apoptosis, in these rapidly proliferating cells.
Etoposide, on the other hand, is classified as a topoisomerase inhibitor, specifically targeting topoisomerase II. This enzyme plays a fundamental role in DNA replication by managing DNA tangles and breaks, allowing the DNA strands to unwind and then re-seal. Etoposide inhibits the re-ligation step, leading to persistent DNA strand breaks that accumulate and become irreparable.
These two drugs are administered together for their synergistic effects. Cisplatin creates DNA damage, while etoposide prevents the repair of these breaks, enhancing their cytotoxic impact. This combination also targets different cellular pathways, making it more effective and potentially overcoming drug resistance. This multi-pronged approach enhances therapeutic benefit.
Cancers Treated
The combination of cisplatin and etoposide is a standard treatment for several aggressive forms of cancer. Small cell lung cancer (SCLC) is a primary indication for this regimen, often as a first-line therapy. It helps control disease progression and improve survival in both limited and extensive stages of SCLC.
This chemotherapy pair is also widely used in treating testicular cancer, including non-seminomatous germ cell tumors, contributing to high cure rates. Ovarian cancer, particularly recurrent or advanced cases, may benefit from this combination. The regimen is also applied in certain types of bladder cancer and some aggressive lymphomas.
Administering the Therapy
Cisplatin and etoposide are administered intravenously (IV) in a vein, such as in the arm or via a central line. Administration occurs in a clinic or hospital, with close monitoring by healthcare professionals.
The treatment is given in cycles, involving a specific schedule of drug administration followed by a rest period. For example, etoposide might be given daily for three to five days, with cisplatin administered on the first day, followed by a recovery period of 16 to 21 days before the next cycle begins. This allows the body time to recover before the next dose. During infusion, patients are monitored for immediate reactions, and hydration protocols are implemented to protect the kidneys, especially with cisplatin.
Managing Side Effects
Patients undergoing cisplatin and etoposide chemotherapy experience side effects due to their impact on healthy rapidly dividing cells. Nausea and vomiting are common, but managed with antiemetic medications. Fatigue is also common, varying in severity, and patients are encouraged to balance activity with rest.
Hair loss begins a few weeks into treatment and is temporary, with regrowth after therapy. Myelosuppression, a reduction in blood cell counts, is a concern. It can lead to increased infection risk due to low white blood cells, anemia from low red blood cells, and increased bruising or bleeding from low platelets. To manage low blood counts, growth factors may be administered to stimulate white blood cell production, and blood transfusions might be given for severe anemia or low platelets.
Peripheral neuropathy, causing numbness, tingling, or pain in the hands and feet, can develop, particularly with cisplatin, and its management focuses on symptom relief. Kidney issues can also arise from cisplatin, requiring careful hydration before, during, and after infusions to protect renal function. Less common but serious side effects such as hearing loss (ototoxicity) or severe allergic reactions can occur. Patients should promptly report any new or worsening symptoms to their medical team for evaluation.
Important Considerations for Patients
Before beginning cisplatin and etoposide therapy, patients undergo baseline tests, including blood work and imaging, to assess health and cancer extent. Discussions with the healthcare team about side effects, treatment goals, and personal concerns are encouraged.
During treatment, communication with the medical team is important for addressing any emerging side effects or concerns. Adhering to hydration protocols, often involving intravenous fluids, helps protect the kidneys from cisplatin-related damage. Due to the risk of myelosuppression, preventing infections by practicing good hygiene and avoiding crowded places is advised. Nutritional support, including dietary adjustments or supplements, can help maintain strength and manage treatment-related weight changes.
Following therapy, patients enter follow-up care, including regular appointments and scans to monitor recovery and check for recurrence. Recovery is a gradual process, involving physical healing and emotional adjustment. Prioritizing emotional support (family, friends, support groups, counseling) and self-care contributes to overall well-being throughout and after treatment.
References
PubChem. Cisplatin. National Library of Medicine. https://pubchem.ncbi.nlm.nih.gov/compound/Cisplatin
PubChem. Etoposide. National Library of Medicine. https://pubchem.ncbi.nlm.nih.gov/compound/Etoposide
National Cancer Institute. Small Cell Lung Cancer Treatment (Adult) (PDQ®)–Health Professional Version. https://www.cancer.gov/types/lung/hp/small-cell-lung-treatment-pdq