ETI

An oral out-patient regimen for:

1. elderly patients aged > 65 years with newly diagnosed AML and not deemed suitable for trial entry
2. AML subsequent to myelodysplastic disorders
Drugs/Dosage/Administration:
Day
1-5
(10 doses)

Drug
Etoposide

1-5
(10 doses)
1, 2 and 3
(3 doses)

Tioguanine

Dose
80mg/m2
(available as 50mg and
100mg capsules)

Idarubicin

100mg/m2
(available as 40mg tablets)
15mg/m2
(available as 5mg, 10mg
and 25mg capsules)

Route
Oral swallowed whole with
a glass of water an hour
before food or on an empty
stomach
Oral swallowed whole with
a glass of water
Oral swallowed whole

Frequency
Every 12 hours

Every 12 hours
Once daily in the
mornings

Other Drugs:

Allopurinol 300mg po daily, ideally starting 24 hours before chemotherapy review after 3
weeks
Fluconazole as initial antifungal prophylaxis
Consider aciclovir prophylaxis (400mg bd), especially if history of VZV or HSV reactivation
Laxative as required for 5HT3 antagonist-induced constipation

Frequency:

usually 2 cycles given 3 weeks apart, assuming counts have recovered

Main Toxicities:

prolonged (> 7 days) myelosuppression, with risk of infections and haemorrhage (see
Comments);
alopecia;
mucositis;
cardiomyopathy;
liver toxicity (tioguanine);
ovarian failure; infertility

Anti- emetics:

moderately emetogenic as out-patient, use oral 5HT3 antagonist (plus laxative cover) on
Day 1 to Day 5

Regular
Investigations:

FBC
U&Es
Mg2+ and Ca2+
LFTs
MUGA/echo

Comments:

Maximum cumulative dose of oral idarubicin not known, but total doses up to 400mg/m 2 not
considered to be problematic. Check any previous anthracycline exposure, particularly if AML
is 2nd malignancy.

twice weekly
twice weekly
baseline
twice weekly
see Comments

A baseline MUGA scan/echocardiogram should be performed where the patient is considered

at risk of having impaired cardiac function e.g. significant cardiac history, hypertension,
obese, smoker, 70 years old, previous exposure to anthracyclines, previous thoracic
radiotherapy. MUGA scan/echo should be repeated if there is suspicion of cardiac toxicity at
any point during treatment.
Reason for Update: general review
Version: 4
Supersedes: Version 3
Prepared by: S Taylor

Approved by Chair of Network TSSG: Dr A Laurie

Date: 28.4.14
Review date: May 2017
Checked by: C Tucker
Page 1 of 2

Dose Modifications
Haematological
Toxicity:

Proceed with treatment only if neutrophils 1.0 x 109/L and platelets 100 x
109/L. If low counts are thought to be due to disease, discuss with Consultant.
Delay in count recovery after treatment should be managed according to local
protocols/practice
If neutropenic sepsis develops, admit and follow neutropenic sepsis protocol, including
reverse barrier nursing.

Renal Impairment:
CrCl (ml/min)
> 50
15 50
< 15

Etoposide Dose
Give 100%
Give 75%
Give 50%

Serum Creatinine (mol/l)

100 175
> 175

Idarubicin Dose
Give 50% dose
Clinical decision

Consider a dose reduction of tioguanine if impaired renal function, but no formal

recommendation.
Hepatic Impairment:
Bilirubin (mol/L)
40 85
> 85

Idarubicin Dose
Give 50% dose
Omit

Creatinine clearance is the strongest predictor of etoposide clearance. There is conflicting

information about dose reduction with hepatic impairment. Use the table below, but discuss
with Consultant before any dose reductions are made.
Bilirubin (mol/l)
26 51
or
> 51
or

AST (units/l)
60 180
> 180

Etoposide Dose
Give 50% dose
Clinical decision

Consider a dose reduction of tioguanine if impaired liver function, but no formal

recommendation.
Patient Information:

Macmillan leaflets for Idarubicin, Etoposide and Tioguanine

References:

Ruutu, T et al; Leukaemia 1994; 8 (1): 11 15

Ruutu, T et al ; Eur J Haematol 2004: 72: 3844

Reason for Update: general review

Version: 4
Supersedes: Version 3
Prepared by: S Taylor

Approved by Chair of Network TSSG: Dr A Laurie

Date: 28.4.14
Review date: May 2017
Checked by: C Tucker
Page 2 of 2