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Japanese Journal of Cancer Research : Gann logoLink to Japanese Journal of Cancer Research : Gann
. 1996 Aug;87(8):856–861. doi: 10.1111/j.1349-7006.1996.tb02111.x

Therapeutic Drug Monitoring in 21‐Day Oral Etoposide Treatment for Lung Cancer

Yuichi Ando 1,2, Hironobu Minami 1, Hideo Saka 1, Masahiko Ando 2, Shuzo Sakai 2, Kaoru Shimokata 1,✉
PMCID: PMC5921180  PMID: 8797893

Abstract

We aimed to determine whether or not therapeutic drug monitoring is applicable to 21‐day oral etoposide treatment for lung cancer. As the starting dose, a 25‐mg capsule of etoposide was taken orally three times daily (75 mg/body). To achieve the target concentration range of 1.0 to 1.5 μg/ml, the dose was changed to two (50 mg/body) or four (100 mg/body) times a day from day 5, depending on the mean concentration obtained on days 3 and 4 (Cbefore). The mean concentration was calculated by use of a limited sampling model we constructed previously. Among 26 courses in 15 patients, two patients experienced grade 4 leukopenia plus neutropenia, and one of them died on day 20. Because nausea/emesis prevented the planned dose escalation in one patient, we excluded two courses of this patient from the pharmacokinetic analysis of dose modification. Among 5 courses with dose reduction, the Cbefore of 1.7±0.1 (μg/ml, mean±SE) was decreased to 1.3±0.2 after day 5 (Cafter). Among 7 courses with dose escalation, the Cbefore of 0.9±0.0 was increased to the Cafter of 1.2±0.1. Among the remaining 12 courses without dose modification, the Cbefore and the Cafter were 1.2±0.0 and 1.3±0.1, respectively. Hematologic toxicities tended to correlate with the drug concentration. TDM is thus applicable to oral etoposide given according to this schedule, and a larger study is now needed to confirm that the therapeutic efficacy is improved by introducing TDM.

Keywords: Oral etoposide, Low dose, Drug monitoring, Pharmacokinetics, Lung cancer

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