Teniposide

• Class: Epipodophyllotoxin derivative (semisynthetic, from podophyllotoxin).
• Pharmacological group: Topoisomerase II inhibitor (plant-derived cytotoxic, but not a true alkaloid).
• Brand name: ® (discontinued in many regions, but still recognized).

Mechanism of Action (MOA)

• Binds to the DNA–topoisomerase II complex → prevents re-ligation of DNA strands → accumulation of double-strand breaks → apoptosis.
• Cell cycle–specific: active mainly in the S and G2 phases.

Clinical Uses

• Acute lymphoblastic leukemia (ALL) (especially refractory/relapsed pediatric cases).
• Sometimes in non-Hodgkin lymphoma, Hodgkin lymphoma, brain tumors, neuroblastoma (protocol-dependent).
• Less commonly used than etoposide.

Dosing (Adults)

• ALL (relapsed/refractory): 165 mg/m² IV once daily × 5 days, every 3–4 weeks (protocol-specific).
• Pediatric dosing: Adjusted per protocol, often 165 mg/m² IV daily × 5 days.
• Requires adjustment in hepatic and renal impairment.

Toxicities

• Dose-limiting: Myelosuppression (severe neutropenia, thrombocytopenia).
• Hypotension (if infused rapidly → must infuse slowly).
• Mucositis, nausea, vomiting, diarrhea.
• Alopecia.
• Hypersensitivity reactions (rare, due to solvent components).
• Secondary AML/MDS risk (like etoposide, esp. with prolonged exposure).

Monitoring

• CBC with differential.
• Liver and renal function.
• Blood pressure during infusion (avoid rapid IV push).
• Long-term: monitor for secondary leukemia.

Summary

Teniposide is a topoisomerase II inhibitor used mainly in pediatric ALL and some lymphomas/brain tumors. It is less widely used than etoposide but has similar efficacy and toxicity. Key concerns are myelosuppression, infusion-related hypotension, and secondary leukemia risk.