Chronic daily administration of oral etoposide in refractory lymphoma

In a phase II study, 25 patients with previously treated lymphoma received oral etoposide for 21 consecutive days. All patients were considered incurable with standard therapy. Etoposide was administered at 50 mg/m² per day: courses were repeated every 28-35 days, depending on myelosuppression. 15 patients (60%) had partial responses (95% CI 41-77%), while 10 patients had no response. Median time to disease progression was 5 months (range 2-13 months). Oral etoposide was active against indolent and aggressive (intermediate and high grade) lymphomas; however, median time to progression was only 3 months in aggressive lymphoma compared with 8 months in indolent lymphoma. Myelosuppression was the major side-effect; 7 patients (28%) had a leucocyte nadir below 1000/μl during the first course, and 11 patients required dose reduction during subsequent courses due to unacceptable leukopenia. All patients had total alopecia, but other side-effects were uncommon. These results highlight the importance of schedule in the administration of etoposide.