- 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.