{"entity":{"id":"platinum-etoposide","kind":"drug","name":"Platinum + etoposide (EP / CE)","aka":[],"tldr":"Platinum plus etoposide has been the chemotherapy backbone of small-cell lung cancer for over 40 years, and is now given with immunotherapy.","summary":"Cisplatin or carboplatin with etoposide for 4 (extensive-stage) to 4-6 (limited-stage, with concurrent radiotherapy) cycles. Response rates 60-80% but relapse is near-universal in extensive-stage disease. Carboplatin is preferred with immunotherapy and in frailer patients; cisplatin with concurrent thoracic radiotherapy in fit limited-stage patients.","status":"standard-of-care","asOf":"2026-09-07","wikipedia":"https://en.wikipedia.org/wiki/Etoposide","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Etoposide"}],"tags":[],"related":[],"cancers":["sclc","limited-stage-sclc","extensive-stage-sclc","extrapulmonary-nec"],"sections":[],"technologies":["cytotoxic-chemotherapy","platinum","topoisomerase-inhibitors"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["limited-extensive-stage"],"trials":["impower133","caspian","astrum-005"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"modality":"Cytotoxic regimen","mechanism":"Platinum DNA crosslinks plus topoisomerase-II inhibition by etoposide.","approvals":[{"region":"US","year":1983,"indication":"Etoposide approved for SCLC; platinum-etoposide became standard in the 1980s"}],"mechanismSteps":["Platinum forms intrastrand DNA crosslinks","Etoposide traps topoisomerase II on DNA, causing double-strand breaks","Rapidly dividing SCLC cells (near-universal RB1 and TP53 loss) cannot arrest and undergo apoptosis","Surviving clones re-emerge within months, often with lineage plasticity"],"dosing":{"route":"Intravenous","schedule":"Carboplatin AUC 5 day 1 (or cisplatin 75 mg/m² day 1) + etoposide 100 mg/m² days 1-3, every 21 days, 4 cycles","modifications":"Dose reductions for neutropenia; G-CSF support with concurrent radiotherapy is avoided","monitoring":"Blood counts each cycle; renal function and hearing with cisplatin"},"toxicity":[{"event":"Neutropenia (grade 3+)","grade3PlusPct":40,"note":"Range across trials 23-45%"},{"event":"Anaemia","anyGradePct":40},{"event":"Nausea","anyGradePct":50},{"event":"Alopecia","anyGradePct":60}],"access":[],"regulatoryEvents":[]},"route":"/drugs/platinum-etoposide/","neighbours":{"cancer":[{"id":"cup-favourable-subsets","kind":"cancer","name":"Cancer of unknown primary, favourable subsets","route":"/cancers/cup-favourable-subsets/"},{"id":"egfr-mutant-nsclc","kind":"cancer","name":"EGFR-mutated non-small-cell lung cancer","route":"/cancers/egfr-mutant-nsclc/"},{"id":"esthesioneuroblastoma","kind":"cancer","name":"Esthesioneuroblastoma (olfactory neuroblastoma)","route":"/cancers/esthesioneuroblastoma/"},{"id":"extensive-stage-sclc","kind":"cancer","name":"Extensive-stage small-cell lung cancer","route":"/cancers/extensive-stage-sclc/"},{"id":"extrapulmonary-nec","kind":"cancer","name":"Extrapulmonary neuroendocrine carcinoma","route":"/cancers/extrapulmonary-nec/"},{"id":"grade-3-net","kind":"cancer","name":"Grade 3 well-differentiated neuroendocrine tumour","route":"/cancers/grade-3-net/"},{"id":"limited-stage-sclc","kind":"cancer","name":"Limited-stage small-cell lung cancer","route":"/cancers/limited-stage-sclc/"},{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"merkel-cell-carcinoma","kind":"cancer","name":"Merkel cell carcinoma","route":"/cancers/merkel-cell-carcinoma/"},{"id":"sinonasal","kind":"cancer","name":"Nasal cavity and paranasal sinus cancers (including esthesioneuroblastoma)","route":"/cancers/sinonasal/"},{"id":"prostate-nepc","kind":"cancer","name":"Neuroendocrine and small-cell prostate cancer","route":"/cancers/prostate-nepc/"},{"id":"sinonasal-undifferentiated-carcinoma","kind":"cancer","name":"Sinonasal undifferentiated carcinoma (SNUC) and SWI/SNF-deficient sinonasal carcinoma","route":"/cancers/sinonasal-undifferentiated-carcinoma/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"}],"technology":[{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"},{"id":"platinum","kind":"technology","name":"Platinum agents","route":"/technologies/platinum/"},{"id":"topoisomerase-inhibitors","kind":"technology","name":"Topoisomerase-I inhibitors (and ADC payloads)","route":"/technologies/topoisomerase-inhibitors/"}],"term":[{"id":"limited-extensive-stage","kind":"term","name":"Limited-stage vs extensive-stage (small-cell lung cancer)","route":"/terms/limited-extensive-stage/"}],"trial":[{"id":"astrum-005","kind":"trial","name":"ASTRUM-005","route":"/trials/astrum-005/"},{"id":"caspian","kind":"trial","name":"CASPIAN","route":"/trials/caspian/"},{"id":"impower133","kind":"trial","name":"IMpower133","route":"/trials/impower133/"},{"id":"turrisi-intergroup-0096","kind":"trial","name":"Intergroup 0096 (Turrisi): twice-daily versus once-daily thoracic radiotherapy","route":"/trials/turrisi-intergroup-0096/"}],"pairing":[{"id":"chemo-io-then-maintenance-sclc","kind":"pairing","name":"Chemo-immunotherapy induction → maintenance intensification (SCLC)","route":"/pairings/chemo-io-then-maintenance-sclc/"}],"paper":[{"id":"paper-amit-induction-chemotherapy-response-snuc-jco-2019","kind":"paper","name":"Induction chemotherapy response as a guide to treatment optimisation in sinonasal undifferentiated carcinoma","route":"/key-papers/paper-amit-induction-chemotherapy-response-snuc-jco-2019/"}],"pathway":[{"id":"lineage-plasticity-neuroendocrine","kind":"pathway","name":"Lineage plasticity & neuroendocrine transformation","route":"/pathways/lineage-plasticity-neuroendocrine/"}]}}