Chronic oral etoposide: trials at Indiana University and with the Hoosier Oncology Group

Etoposide has proven to be an active agent in the treatment of a variety of neoplasms, particularly germ cell cancers and small cell lung cancer. Yet despite its widespread use, the optimal dose and schedule for etoposide remain unknown. The fact that its efficacy appears to be schedule dependent, along with the recent availability of an oral formulation, formed the basis for several trials at Indiana University and through the Hoosier Oncology Group. These trials evaluated chronic daily administration of the drug in several malignancies. In testicular cancer, etoposide was shown to have a possible role in adjuvant therapy for refractory disease or as part of combination chemotherapy. In small cell lung cancer, etoposide demonstrated activity in both previously treated and untreated patients. The drug, however, had little impact on patients with advanced non-small cell lung cancer, advanced melanoma, or advanced soft tissue sarcoma. Since etoposide appears to be most effective in refractory small cell lung cancer and germ cell tumors, we believe the drug should be explored in tumors with a known history of chemosensitivity to conventionally administered etoposide.