Pharmacokinetic aspects of oral etoposide

Background Etoposide is a cytotoxic agent which is frequently employed in paediatric oncology and which is available for intravenous as well as oral application. Many advantages of the formulation for oral use have been opposed by concerns about its interindividually varying bioavailability. The influence of the dosage of etoposide on its activity and toxicity ("schedule dependency") has also been discussed. The present paper deals with the pharmacokinetics of oral etoposide focusing on the interindividual variability. Patients Sixteen patients aged between 3 and 73 years received oral etoposide at a dosage of 28 mg/m(2) to 149 mg/m(2) in combination with oral trofosfamide for palliation. Method HPLC was used to measure total, and free serum etoposide in 16 patients, and the etoposide concentration in several urine samples from 8 patients. Pharmacokinetic parameters were normalized to a dosage of 100 mg/m(2) Results The peak serum concentration, the time to peak concentration, the area under the concentration-time curve, the terminal half-life and the apparent clearance after oral application were calculated to be 6.7 mu g/ml, 2.1 h, 51.8 (mu g h/ml)/(100 mg/m(2)), 5.6 h, and 40.3 ml/min for total etoposide, and 0.23 mu g/ml, 1.9 h, 1.76 (mu g.h/ml)/(100 mg/m(2)), 5.9 h, and 1172 ml/min for free serum etoposide, respectively. On an average, urinary recovery of etoposide was 21% of the oral dose. The fraction of free etoposide was calculated to be close to 4%. Regarding the systemic exposure to etoposide, a variation coefficient of 40% was determined. Additional studies showed that the interindividual variability mainly concerned the peak levels, while the duration for which intermediate etoposide levels were maintained varied less between individuals. On simulating different dosage schedules, it was seen that the duration of intermediate concentrations (0.5-2 mu g/ml) may be extended significantly by dividing the daily dose of etoposide into two oral applications. Conclusion The total systemic exposure under oral etoposide treatment varies considerably between individuals. Extended intervals of intermediate etoposide concentration and less variation are, however, possible with oral therapy, Dividing the daily dose into two applications seems advisable, Future studies are warranted to test hypotheses on pharmacokinetic-pharmacodynamic aspects by pharmacological drug monitoring.