At a glance
| Chemical family | An antineoplastic (chemotherapy) drug — a semi-synthetic podophyllotoxin and DNA topoisomerase II inhibitor (VP-16) |
| CAS number | 33419-42-0 |
| Classification | IARC Group 1 (carcinogenic to humans) — upgraded from the original 2000 finding of Group 2A alone (Group 1 was originally reserved for the cisplatin+bleomycin combination). Associated with treatment-related acute myeloid leukaemia; a NIOSH hazardous drug |
| Where you encounter it | Only in a home where someone is being treated: excreted in urine and other body fluids, depositing on toilet/bathroom surfaces, bedding and laundry |
| Sleep micro-environment relevance | A household caregiver- and laundry-hygiene concern — contaminated bedding and surfaces, not the mattress — for a limited period after each dose |
| Activated carbon capture | Not relevant — this is a surface/laundry-residue issue managed by gloves, separate laundering and cleaning, not air filtration |
Regulatory & certification status
Where Etoposide stands across the major regulatory systems and the certifications a bedroom product might carry. Each row links to the governing instrument; where a jurisdiction has no specific measure, that is stated plainly rather than left blank.
| European Union | No REACH SVHC Candidate List, Authorisation-List (Annex XIV), or Annex XVII restriction entry was identified for etoposide, and no CLP Annex VI harmonised classification was confirmed (pharmaceutical active substances used as such fall largely outside REACH scope). Etoposide does appear on the EU indicative list of hazardous medicinal products (Commission Communication C/2025/1150, issued under the Carcinogens, Mutagens and Reprotoxic Substances Directive 2004/37/EC), i.e. it is treated as a substance meeting the CLP criteria for classification as a carcinogen and mutagen (category 1A/1B) for the purpose of workplace protection. This reflects EU/manufacturer self-classification, not a harmonised legal classification. Regulatory — EUR-Lex |
| United States | Listed under California Proposition 65 for cancer (listed 04 Nov 2011, via the Labor Code listing mechanism) and for developmental toxicity (listed 01 Jul 1990). Both listings are confirmed on the official OEHHA Proposition 65 chemical page. Etoposide is a pharmaceutical active ingredient rather than an industrial-use chemical, and no EPA TSCA risk evaluation or FIFRA pesticide action was identified for it. Regulatory — OEHHA |
| Canada | In its published screening assessment of etoposide (CAS 33419-42-0), Environment and Climate Change Canada / Health Canada concluded that the substance does not meet any of the criteria set out in section 64 of CEPA 1999. Etoposide is therefore NOT on Schedule 1 of CEPA. (Etoposide had originally been prioritised over a potential carcinogenicity hazard, but the assessment did not find it met the section 64 criteria.) Regulatory — Government of Canada |
| Australia | Etoposide is an antineoplastic medicine regulated as a therapeutic good by the TGA, not as an industrial chemical under AICIS. No AICIS/IChEMS or legacy NICNAS industrial-chemical assessment was identified for this substance. Regulatory — AICIS |
| United Kingdom | The UK (GB) REACH Candidate List of SVHCs is based on the EU SVHC list inherited at the end of the Brexit transition; etoposide is not on the UK REACH Candidate List. No GB CLP harmonised CMR entry for etoposide was identified, and no UK REACH Authorisation requirement applies. Regulatory — HSE |
| International | IARC classifies etoposide as Group 1 (carcinogenic to humans). In the original evaluation (Monographs Vol. 76, 2000) etoposide alone was Group 2A while etoposide in combination with cisplatin and bleomycin was Group 1; in the Vol. 100A re-evaluation (2012) the overall evaluation of etoposide was upgraded to Group 1 on the basis of mechanistic and other relevant data. No Stockholm Convention POP or Minamata Convention listing was identified. Regulatory — IARC · IARC Monographs Vol. 100A |
| Certifications | None of these consumer-product certifications name etoposide, which is a chemotherapy drug substance with no role in mattress, foam or textile manufacture. CertiPUR-US is a flexible-foam content/emissions program and does not address it; OEKO-TEX Standard 100 is a textile chemical-residue standard and does not list it; GREENGUARD/GREENGUARD Gold is a low-VOC emissions certification and would not screen for a non-volatile pharmaceutical of this kind. This is a reasoned non-coverage finding based on each program's published scope, not an entry naming the compound. Industry — CertiPUR-US · OEKO-TEX |
| The 72-hour test window | Not applicable / would be missed. Etoposide is a high-molecular-weight (~588 g/mol), non-volatile solid pharmaceutical, so a short ~72-hour VOC chamber test would not detect it; more fundamentally, it is not a sleep-environment emission compound and would not be present in bedroom materials. Inferred — from the compound's volatility/emission profile versus the VOC focus of short chamber tests |
What it is
Etoposide — known in the clinic as VP-16 — is a semi-synthetic derivative of podophyllotoxin and one of the most widely used cytotoxic chemotherapy drugs, given for lymphoma, small-cell lung cancer, testicular and other germ-cell tumours, and a range of childhood cancers. Regulatory — IARC Monograph Vol. 76 It works by poisoning DNA topoisomerase II, an enzyme cells need to manage their DNA during division — which is precisely how it kills rapidly dividing cancer cells, and also why it has a carcinogenic edge of its own.
It is important to be exact about that edge, including its history. IARC's original 2000 evaluation (Volume 76) classified etoposide alone as only probably carcinogenic to humans (Group 2A); the evidence reached carcinogenic to humans (Group 1) only for the specific combination with cisplatin and bleomycin. Regulatory — IARC Monograph Vol. 76 That changed in 2012: IARC's Volume 100A re-evaluation upgraded etoposide alone to Group 1, based on mechanistic and other relevant data rather than new epidemiology — the drug's signature chromosomal damage was judged sufficient on its own. Regulatory — IARC current classification list The current, authoritative classification is therefore Group 1 for etoposide on its own. The concern is a treatment-related acute myeloid leukaemia that can follow therapy after an unusually short latency, marked by balanced translocations of the MLL gene at chromosome 11q23 — a signature distinct from the leukaemias caused by alkylating-agent chemotherapy. Regulatory — IARC Monograph Vol. 76
How it relates to the bedroom
The household route: excretion onto bedding and surfaces
Etoposide reaches the sleep environment by a route unique to this drug family. About half of a dose is excreted in urine, so for several days after each treatment the patient's body fluids carry the drug — and it deposits onto the surfaces and fabrics they contact. Regulatory — IARC Monograph Vol. 76 Surveys of oncology wards make this concrete: etoposide was detectable on a substantial share of tested surfaces, with toilet seats a prominent hot spot, and the authors explicitly note the exposure risk extends beyond staff to "patients, family members and visitors." Peer-reviewed — Walton et al. 2020
The bedding link is not hypothetical, though the strongest direct evidence for it comes from etoposide's drug-class relatives rather than etoposide itself. A biomonitoring study of nurses handling five antineoplastic drugs (cyclophosphamide, ifosfamide, methotrexate, 5-fluorouracil, doxorubicin — etoposide was not among the drugs measured) found that changing the sheets or making the bed of a treated patient was one of the strongest contributors to measurable drug uptake. Peer-reviewed — Villa et al. 2023 Etoposide shares the same excretion-onto-fabric mechanism as those drugs, so the same household route plausibly applies — but that extension is a reasonable inference, not a direct measurement. Inferred — same excretion mechanism as the antineoplastic drugs Villa et al. studied In a home, the person doing that task is usually a family caregiver — which is exactly why this belongs in a bedroom atlas.
Keeping it in proportion
The calibration here matters as much as the facts. The serious carcinogenic risk attaches to receiving the drug as treatment, not to a caregiver's incidental contact with traces on laundry; documented third-party exposures are low-level, and the right response is sensible hygiene, not alarm. Inferred — third-party household exposure is low-level relative to therapeutic dosing; the precaution is hygiene, following the ALARA principle The drug itself is a cornerstone of curing several cancers. The task is simply to keep a caregiver's exposure as low as reasonably achievable during the short window when the drug is being cleared.
What the research says
- IARC Group 1 (carcinogenic to humans). Originally Group 2A alone in 2000 (Vol. 76); upgraded to Group 1 in the 2012 re-evaluation (Vol. 100A) on mechanistic grounds. Treatment-related acute myeloid leukaemia with MLL/11q23 translocations and short latency. Regulatory — IARC current classification list
- Excreted and surface-deposited. ~50% urinary excretion; etoposide found on oncology-unit surfaces including toilet seats. Peer-reviewed — Walton et al. 2020
- Bedding is a plausible route. Sheet-changing/bed-making is strongly associated with measurable internal contamination for related antineoplastic drugs; etoposide was not itself among the drugs measured, but shares the same excretion mechanism. Peer-reviewed — Villa et al. 2023 (drug class, not etoposide-specific)
- Risk extends beyond staff. Patients, family members and visitors are named as potentially exposed. Peer-reviewed — Walton et al. 2020
What helps reduce it
Follow your care team's home-chemo precautions. These generally apply for about a week after each dose and are designed for exactly this situation. Inferred — standard home-chemotherapy caregiver guidance
Glove up and launder separately. Wear disposable gloves for soiled linens or body fluids; wash contaminated bedding and clothes apart from other laundry with an extra rinse. Inferred — standard precaution for antineoplastic-drug excretion onto fabric, extrapolated from Villa et al. 2023's findings in related drugs
Manage the bathroom. Close the lid before flushing, clean toilet and bathroom surfaces, and wash hands afterward — the documented hot spots. Peer-reviewed — Walton et al. 2020
What does NOT help
- Replacing the mattress. The drug is not in the bed; it is a transient excreted residue managed by hygiene and laundering. Inferred
- Fearing the medicine. Etoposide is a cornerstone cancer treatment; the household task is sensible precaution, not avoidance of therapy. Regulatory — IARC Monograph Vol. 76
Open research questions
- The real magnitude of any health risk to home caregivers from low-level excreted-drug contact, which current data cannot quantify well. Speculation
- How long after a dose bedding and bathroom surfaces remain meaningfully contaminated in a home setting. Speculation
The Embr Exposure Ledger: Etoposide
One chemical, several public questions, answered from independent datasets and joined here — the environment it shows up in, the body burden it carries, how it is regulated, and what actually reduces it.
Detection and body-burden figures are occurrence data, not a personal measurement or a health diagnosis. Part of the Embr Exposure Ledger — an open, cross-dataset chemical join (download the data), reusable with attribution.
Citations
- IARC Monographs Volume 76 (2000): Etoposide. DNA topoisomerase II inhibitor; original evaluation was Group 2A alone / Group 1 with cisplatin + bleomycin; treatment-related AML with MLL/11q23 translocations and short latency; ~50% urinary excretion. IARC / IPCS INCHEM Regulatory
- IARC — Agents Classified by the IARC Monographs, Volumes 1-141 (current classification list, last updated 27 March 2026). Etoposide's overall evaluation was upgraded to Group 1 (carcinogenic to humans) in the Volume 100A (2012) re-evaluation, on the basis of mechanistic and other relevant data. IARC current classification list Regulatory
- Walton AM, et al. (2020). Surface contamination with antineoplastic drugs on two inpatient oncology units. Oncology Nursing Forum. Etoposide on 31% (cyclophosphamide 61%) of surfaces; toilet seats prominent; exposure risk to healthcare workers, patients, family members and visitors. Via Consensus. DOI 10.1188/20.onf.263-272 Peer-reviewed
- Villa A, et al. (2023). Factors associated with internal contamination of nurses by antineoplastic drugs. Int. J. Hyg. Environ. Health. Studied five antineoplastic drugs (cyclophosphamide, ifosfamide, methotrexate, 5-fluorouracil, doxorubicin) — etoposide was not among them. Changing sheets / making the bed of a treated patient strongly associated with internal contamination (OR ~10) for that drug class; cited here as evidence for the shared excretion-onto-fabric mechanism, not as an etoposide-specific measurement. Via Consensus. DOI 10.1016/j.ijheh.2023.114264 Peer-reviewed
Frequently asked questions
What is etoposide?
Etoposide (also called VP-16) is a widely used chemotherapy drug — a DNA topoisomerase II inhibitor given for lymphoma, small-cell lung cancer, testicular and other germ-cell tumours, and several childhood cancers. It is a valuable, often life-saving cancer treatment. It appears in this Atlas not as something in your mattress, but because of what happens after a patient takes it: about half is excreted in urine, and traces end up on surfaces and bedding.
How is it classified for cancer risk?
Precisely stated: etoposide on its own is classified by IARC as probably carcinogenic to humans (Group 2A), while etoposide given in combination with cisplatin and bleomycin is carcinogenic to humans (Group 1). The concern is treatment-related acute myeloid leukaemia, which can follow etoposide therapy after a short latency. This is a recognized, if uncommon, risk of the treatment itself — separate from the much lower-level question of third-party household exposure.
Why does it matter in the bedroom?
When someone in a home is being treated with etoposide, the drug and its metabolites leave their body in urine and other excreta for a few days after each dose. Studies on oncology units have found etoposide on surfaces including toilet seats. A separate study of related antineoplastic drugs (not including etoposide itself) found that changing the sheets or making the bed of a treated patient was a measurable route by which others picked up the drug — a plausible extension to etoposide given the shared excretion mechanism, though not a direct measurement. So for a household caregiver, contaminated bedding and bathroom surfaces — not the mattress itself — are the exposure to manage.
What should a caregiver do?
Follow the standard home-chemotherapy precautions your care team provides, generally for about a week after each dose. Wear disposable gloves when handling soiled linens or bodily fluids, wash contaminated bedding and clothing separately from other laundry (and run an extra rinse), close the toilet lid before flushing and clean bathroom surfaces, and wash hands afterward. The aim is to keep third-party exposure as low as reasonably achievable while the patient gets a vital treatment.
Related compounds
Embr is a sleep environment company researching and addressing the chemistry of the bedroom. Research and product development in progress. This page is informational and is not medical advice; follow your care team's guidance.
Last reviewed 2026-07-07 (classification corrected to IARC Group 1 — see citations). If you find a factual error, contact us.