Carboplatin and etoposide

Say it: KAR-bo-PLA-tin and ee-TOE-po-side

Carboplatin and etoposide

Carboplatin and etoposide is a two medicine chemotherapy that is the main treatment for small cell lung cancer, often given with an immunotherapy or with radiation.

Also called: carbo etop, carbo/etoposide, carbo VP-16, carboplatin VP-16, CE, EC, EP, cisplatin etoposide, carbo etoposide atezolizumab, carbo etoposide durvalumab, IMpower133 regimen, CASPIAN regimen

What it is

Carboplatin and etoposide damage cancer cells in two different ways. Small cell lung cancer usually shrinks quickly with this treatment. When the cancer has spread, an immunotherapy (atezolizumab or durvalumab) is added to help your immune system keep the cancer under control, and the goal is to shrink it and help you live longer and feel better. When the cancer is only in the chest, chemotherapy is given with radiation and the goal is cure.

Often used for

• Small cell lung cancer that has spread (extensive stage), usually with an immunotherapy added
• Small cell lung cancer that is only in the chest (limited stage), given with radiation, often with cisplatin in place of carboplatin
• Large cell neuroendocrine lung cancer
• Other fast growing (high grade) neuroendocrine cancers outside the lung

With atezolizumab (extensive stage)

Atezolizumab, carboplatin and etoposide are given together every 21 days for 4 cycles. Then chemotherapy stops and atezolizumab continues alone every 3 or 4 weeks as long as it is working. For some people, lurbinectedin (another chemotherapy) may be added to atezolizumab during maintenance.

With durvalumab (extensive stage)

Durvalumab, carboplatin (or cisplatin) and etoposide are given together every 21 days for 4 cycles. Then durvalumab continues alone every 4 weeks as long as it is working.

With radiation (limited stage)

For cancer only in the chest, cisplatin and etoposide are most often used, with carboplatin used when cisplatin is not safe. Usually 4 cycles are given every 21 days, with chest radiation starting during the first or second cycle. Radiation is given once a day for about 6 to 7 weeks, or twice a day for about 3 weeks. Afterward, many people get durvalumab every 4 weeks for up to 2 years.

Chemotherapy alone

Carboplatin and etoposide without immunotherapy, usually 4 to 6 cycles, may be used when immunotherapy is not safe, such as for some people with serious autoimmune disease.

The medicines in this plan

Carboplatin

Platinum chemotherapy. Given through a vein over about 30 to 60 minutes on day 1. Your dose is based on how well your kidneys work.

Etoposide

Chemotherapy that stops cancer cells from repairing and copying their DNA. Given through a vein over about 1 hour on days 1, 2 and 3. Sometimes the day 2 and 3 doses are taken as pills at home.

Atezolizumab

Only in the atezolizumab version. Immunotherapy that takes the brakes off your immune system. Given through a vein on day 1, then continued as maintenance.

Durvalumab

Only in the durvalumab version, or after radiation for limited stage. Immunotherapy that works like atezolizumab. Given through a vein over about 1 hour on day 1, then continued as maintenance.

Cisplatin

Only in the cisplatin version. Platinum chemotherapy given through a vein in place of carboplatin, with extra IV fluids to protect the kidneys.

How you get it

Carboplatin and etoposide are given in an outpatient infusion clinic every 21 days, through an IV or a port (a small device placed under the skin of the chest). Day 1 takes about 3 to 4 hours, and days 2 and 3 are shorter visits for etoposide (unless you take etoposide pills at home). Most people get 4 cycles, about 3 months. Then immunotherapy often continues alone. Your schedule may be different.

A typical cycle

Day 1

Blood tests and a check in with your team. Then anti-nausea medicines, then any immunotherapy, then carboplatin and etoposide.

Days 2 and 3

Short clinic visits for IV etoposide, or etoposide pills at home if your team prescribed them.

Days 4 to 7

Tiredness and nausea are most common now. A white blood cell booster shot may be given.

Days 8 to 15

Blood counts are lowest. Watch closely for fever and signs of infection.

Days 16 to 21

Recovery before the next cycle. Scans are usually done every 2 cycles at first.

Common side effects and what helps

• Low blood counts, which are common with this plan and raise the risk of infection, bleeding and tiredness. Wash hands often and stay away from people who are sick.
• Hair loss, usually starting 2 to 3 weeks after the first treatment. It grows back after chemotherapy ends.
• Tiredness. Rest when you need to and try a short walk each day.
• Nausea and poor appetite. Take your anti-nausea medicines as prescribed, even before you feel sick.
• Mouth sores. Rinse often with a mild salt and baking soda rinse and use a soft toothbrush.
• Constipation or diarrhea. Drink plenty of fluids and ask about medicines that help.
• With radiation: sore throat and painful swallowing, cough and skin redness on the chest. Soft foods and prescribed mouth rinses help.
• With immunotherapy: rash, itching, diarrhea or thyroid changes. Report them early so they can be treated.
• With cisplatin: more nausea, ringing in the ears or hearing changes, and tingling in hands and feet.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• Trouble breathing, chest tightness, flushing, rash or swelling of the face or throat during or soon after the infusion
• New or worse cough, shortness of breath or chest pain
• Diarrhea 4 or more times a day above your normal, or blood in your stool
• Yellow skin or eyes, or dark urine
• Confusion, a very bad headache, new weakness, trouble speaking, a seizure or extreme sleepiness
• Not able to keep fluids down, or feeling dizzy when you stand
• Swallowing so painful that you cannot eat or drink (during radiation)
• Bleeding that will not stop, or new bruises you cannot explain

Good to know

• You will have blood tests before each cycle. Because counts can drop a lot, a white blood cell booster may be added to lower infection risk.
• Small cell lung cancer can spread to the brain. Your team may check with a brain MRI and talk with you about radiation to the brain.
• Small cell lung cancer can lower the salt (sodium) level in your blood, which can cause confusion or weakness. Blood tests check for this.
• Immunotherapy side effects can affect any organ, even months after the last dose. Blood tests check your thyroid, liver and kidneys.
• Cisplatin needs extra IV fluids and can affect the kidneys and hearing, so these are checked during treatment.
• Stopping smoking helps treatment work better and lowers side effects from radiation. Ask your team for help quitting.
• Do not get pregnant or father a child during treatment; use birth control your team approves.

At home

• Keep a thermometer at home and check your temperature if you feel unwell.
• If you take etoposide pills, take them exactly as prescribed on days 2 and 3 and keep them away from children and pets.
• Drink about 8 to 10 cups of fluid a day unless your team told you otherwise.
• During radiation, eat soft, moist foods and use the mouth rinse your team gave you.
• If you get immunotherapy, carry a card or list saying so, and show it at any urgent care or ER.
• Have a family member watch for confusion or unusual sleepiness, and call if they notice it.

Questions to ask

• Is my cancer limited stage or extensive stage, and what is the goal of treatment?
• Will I get carboplatin or cisplatin, and will an immunotherapy be added?
• Will I get radiation to my chest or brain?
• Will I need a white blood cell booster shot?
• How long will I stay on maintenance immunotherapy?
• Can you help me quit smoking?

Lung cancer

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.