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Toposar 20mg/mL Injection
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Indications & Clinical Uses
- Toposar (etoposide injection, USP) 20 mg/mL is manufactured for Pharmacia & Upjohn Company, now part of Pfizer, and contains etoposide, a topoisomerase II inhibitor derived from the mandrake-plant compound podophyllotoxin.
- It is approved, in combination with other approved chemotherapy agents, for refractory testicular tumours that have already been treated with surgery, chemotherapy and radiotherapy, and as first-line combination therapy for small cell lung cancer.
- Toposar is given only by, or under the supervision of, a physician experienced in cancer chemotherapy, as a slow intravenous infusion in a hospital or oncology clinic - it is never self-administered or given as a rapid push.
- Generic etoposide injection from other manufacturers is marketed under the same generic name and, as a different molecule form, under Etopophos (the water-soluble phosphate prodrug, dosed differently); Toposar and Etopophos are not interchangeable milligram-for-milligram.
Side Effects
- Toposar carries a boxed warning that it must be given only under the supervision of a physician experienced in cancer chemotherapy, because severe bone marrow suppression with resulting infection or bleeding may occur.
- Very common effects include low white blood cell counts (leukopenia, seen in 60-91% of patients) and low platelet counts (thrombocytopenia, 22-41%); nausea and vomiting affect 31-43% of patients, and hair loss occurs in up to two-thirds.
- Reduced appetite and diarrhoea are also common.
- Infusing Toposar too quickly can cause a sudden drop in blood pressure, so it is always given slowly over 30 to 60 minutes with monitoring.
- Allergic reactions with chills, fever, breathing difficulty and wheeze occur in about 1-2% of patients and can be severe.
- Report fever, unusual bruising or bleeding, breathing trouble or a rash immediately to your care team.
Precautions & Warnings
- Toposar must be given only by slow intravenous infusion, never as a rapid injection, because rapid administration can cause severe hypotension; blood pressure is monitored during each infusion.
- Full blood counts are checked before every cycle and the dose adjusted for myelosuppression.
- Toposar can cause fetal harm and must be avoided in pregnancy; women and men should use effective contraception during treatment.
- Rare cases of secondary acute leukaemia have been reported after etoposide-containing regimens, sometimes years later.
- Dose reduction is needed in kidney impairment, and etoposide should be used cautiously in significant liver impairment.
- Watch the infusion site closely, as leakage of Toposar into surrounding tissue (extravasation) can cause pain, swelling and, rarely, tissue damage.
- Toposar is prepared and given only in a hospital or oncology day-unit setting, never at home, and diluted solutions must be used within the time stated on the pharmacy label to avoid precipitation.
Avoid Interactions
- High-dose cyclosporine can raise etoposide blood levels by roughly 80% by reducing its clearance, increasing the risk of toxicity, so your oncology team will monitor closely if you are also taking cyclosporine.
- Other highly protein-bound medicines, such as warfarin, may compete with etoposide for binding and need closer INR monitoring.
- Live vaccines should be avoided during and shortly after Toposar treatment because chemotherapy-related immune suppression can make live vaccines unsafe; discuss vaccination timing with your care team.
- Combining Toposar with other bone-marrow-suppressing chemotherapy or radiotherapy increases the risk of severe low blood counts, so doses of each agent in a regimen are planned together.
- Toposar must not be mixed with other medicines in the same syringe or infusion line.
- Tell your oncology team about every prescription, over-the-counter medicine, herbal product and supplement you are taking.
References
Frequently Asked Questions
Toposar (etoposide) treats refractory testicular cancer, combined with other chemotherapy after surgery and radiotherapy have failed, and is used as first-line treatment for small cell lung cancer alongside other agents. It's a topoisomerase II inhibitor given only in a hospital or clinic setting, never at home.
Toposar is given by a slow intravenous infusion over 30 to 60 minutes, by or under the supervision of a cancer specialist. Giving it too fast can cause a sudden drop in blood pressure, so your blood pressure is checked during each infusion. There is no oral or self-injected form of Toposar.
Toposar's boxed warning is severe bone marrow suppression, which can cause serious infection or bleeding; blood counts are checked before every cycle. Very common effects are low white cell and platelet counts, nausea, vomiting and hair loss. Report fever, unusual bleeding or breathing trouble to your care team at once.
Tell your oncology team about cyclosporine, since high doses can raise Toposar (etoposide) levels and increase side effects. Avoid live vaccines during and shortly after treatment because of a weakened immune system. Toposar can harm an unborn baby, so use effective contraception during treatment.
On a Toposar infusion day, blood counts and blood pressure are checked, then the etoposide dose is given slowly through a vein over 30 to 60 minutes. Nurses monitor for sudden low blood pressure or allergic reactions during and after the drip finishes.
Rarely, a secondary acute leukaemia can develop after Toposar treatment, sometimes years later, so long-term follow-up is advised. Toposar can also affect fertility and harm an unborn baby, so discuss contraception and fertility preservation with your oncology team before treatment starts.
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