Topotecan

Topotecan works by interfering with the growth of cancer cells, which are then eventually destroyed.

Overview:

Due to the way the medicine works, other normal cell growth can also be affected by the medicine. The seriousness of the condition and the medicine used to treat it means there are other effects which could arise, any serious ones must be reported to the doctor immediately by the patient.

Conditions Treated:

  • Metastatic cancer of the ovaries
  • Small cell lung cancer
  • Cervical cancer that has returned

Type of medicine:

  • Antineoplastic/cytotoxic Chemotherapy

Side Effects:

As with medications of this nature, there are various side effects that can affect the patient, Topotecan can lower the patient’s white blood cell count in their blood, this can then increase the chance of them getting an infection.

Other key side effects of the medication include:

  • Abdominal or stomach pain
  • Black, tarry stools
  • Blood in the urine or stools
  • Cough or hoarseness (which comes with fever or chills)
  • Fever or chills
  • Lower back or side pain (which comes with fever or chills)
  • Painful or difficult urination (which comes with fever or chills)
  • Pinpoint red spots on the skin
  • Troubled breathing
  • Unusual bleeding to bruising
  • Unusual tiredness or weakness

More common effects are:

  • Burning or tingling in the hands or feet
  • Constipation
  • Diarrhea
  • Headache
  • Loss of appetite
  • Muscle weakness
  • Nausea or vomiting
  • Sores, ulcers, or white spots on the lips, tongue or inside of the mouth
  • Bruising or redness at the place of injection

Other rarer side effects are:

  • Changes in the skin color of the face
  • Fast or irregular breathing
  • Large, hive-like swellings on the face, eyelids, mouth, lips or tongue
  • Puffiness or swelling of the eyelids or around the eyes
  • Skin rash, hives or itching
  • Tightness in the chest
  • Bleeding gums
  • Difficulty with swallowing
  • Dizziness
  • Fast heartbeat
  • Skin rash or itching, severe

Some of these side effects do not need medical attention and as the body adjusts to the medicine, they tend to go away during treatment.

If a patient has concerns they can discuss these with their healthcare professional, who will be able to offer advice on ways to prevent or reduce some of these side effects.

As always, a patient can check with their healthcare professional in regards to any of the described side effects, if they are particularly bothersome or they have concerns.

Dosage:

If a patient is to complete a course of Topotecan, they will receive this medicine while they are in a hospital or cancer treatment center. A nurse or other trained health professional will give this medicine to the patient.

The medicine is administered via intravenous injection into one of the veins.

Usually treatment is given every day for 3 to 5 days. This 3-day or 5-day treatment is given again every 21 days until the body starts to respond to the medicine. A treatment lasts approximately 30 minutes.

When Topotecan is administered it can often cause nausea and vomiting, despite this, it is important that the patient receives the medicine, even if it makes them feel ill. The doctor will be able to provide advice on ways to lessen the effects.

Throughout treatment, the doctor will check the patient’s progress and to ensure that the medicine is working properly. Blood tests can be conducted to check for any unwanted effects.

If a patient is pregnant, then the medicine may harm the unborn baby, it is recommended that patients use an effective form of birth control to prevent pregnancy during treatment and for at least one month after the last dose. If a patient thinks they are pregnant, they are to consult with their doctor immediately.

For a male patient undergoing treatment, the drug may cause birth defects, if his sexual partner becomes pregnant. The male patient is recommended to use an effective birth control throughout treatment and for three months after receiving the medicine.

If the patient plans to have children, they must consult with their doctor as those that have used this medicine have become infertile.

Throughout treatment and after treatment is stopped, a patient must seek their doctor’s approval if they are to have any immunizations. Topotecan can lower the body’s resistance, and the vaccine may not be able to prevent the infection it is meant to. If the patient lives in the same household with someone who has taken oral polio vaccine, there is a possibility that the polio virus could be passed on. It is recommended that patients avoid persons who have taken the vaccine within the past several months. They are advised to not get close to them or stay in the same room with them for very long. If they are unable to take these precautions, they should wear a protective face mask that covers the nose and mouth.

Topotecan temporarily lowers the number of white blood cells, which can increase the chance of getting an infection. It can also lower the number of platelets, which the body needs for proper blood clotting.

To reduce the risk of infection, the patient can take the following precautions:

  • Avoid people with infections – check with their doctor if they think they are getting an infection or if they get fever or chills, cough or hoarseness, lower back or side pain, painful or difficult urination, severe diarrhea, or stomach pain.
  • Check with their doctor if they notice unusual bleeding or bruising.
  • To take caution when using a regular toothbrush, dental floss, or toothpick. A doctor, nurse or dentist can recommend other methods for cleaning gums and teeth.
  • Avoid touching their eyes or the inside of their nose unless their hands have been washed and they have not touched anything else.
  • Take caution when using safety razors, fingernail or toenail cutters.
  • Avoid contact sports or other situations where bruising or injury could occur.
  • Typhlitis (neutropenic enterocolitis) can be caused by this medicine.

As in all cases, if a patient has any concerns or queries they should raise these with a healthcare professional.

Interactions

As is often the case there are medicines that should never be used together, however there are cases in which two different medicines can be used together despite there being an interaction. In this scenario, the doctor may want to change the dose or take other precautions.

Patients must always ensure that they keep a list of all medications that they are currently on, paying particular attention to the dosage and frequency of their medication. This applies to medication that is both prescribed and brought over the counter.

This partial list of drugs is known to have negatively interacted with Toptecan. If the patient is receiving any of these then they must consult with their doctor immediately, before they undertake their first treatment of Topotecan:

  • Measles Virus Vaccine, Live
  • Mumps Virus Vaccine, Live
  • Rotavirus Vaccine, Live
  • Rubella Virus Vaccine, Live
  • Varicella Virus Vaccine

The following list of medicines is not recommended to be used with Topotecan. However, in some cases it may be required. If both are required it is the doctor who will decide to change the dose or how often one or both medicines are used:

  • Abiratone
  • Adenovirus Vaccine
  • Amiodarone
  • Azithromycin
  • Bacillus of Calmette and Guerin Vaccine, Live
  • Captopril
  • Carboplatin
  • Carvedilol
  • Cholera Vaccine, Live
  • Cisplatin
  • Clarithromycin
  • Cobicistat
  • Conivaptan
  • Diltiazem
  • Doxorubicin
  • Doxorubicin Hydrochloride Liposome
  • Dronedarone
  • Eliglustat
  • Eltrombopag
  • Erythromycin
  • Felodipine
  • Filgrastim
  • Influenza Virus Vaccine, Live
  • Itraconazole
  • Ivacaftor
  • Ketoconazole
  • Lomitapide
  • Lopinavir
  • Nilotinib
  • Poliovirus Vaccine, Live
  • Quercetin
  • Quinidine
  • Ranolazine
  • Ritonavir
  • Simeprevir
  • Smallpox Vaccine
  • Sofosbuvir
  • Sunitinib
  • Telaprevir
  • Ticagrelor
  • Tocophersolan
  • Typhoid Vaccine
  • Velpatasvir
  • Verapamil
  • Yellow Fever Vaccine

The doctor should also be notified by the patient of any pre-existing medical conditions, specifically:

  • Infection – this would decrease the body’s ability to fight infection
  • Kidney disease, moderate – This can see an increase in higher blood levels of Topotecan, which increases the risk of serious side effects.
  • Lung disease (eg, interstitial lung disease), or history of
  • Neutropenia (low white blood cells) – Using Topatecan could make these conditions worse.

If the patient drinks alcohol or smokes tobacco, then they must discuss this with their doctor. It is important that the patient outlines the details of their diet and anything else they consume so a doctor can make a decision on the treatment.

Warnings:

With this medicine, the risks of using Topatecan must be weighed against its effectiveness in combating the condition. This is a decision that the doctor must take. They would take the following into consideration when making this decision:

Allergies

The patient must make their doctor aware if they have ever had any unusual reactions to this medicine or any other medicines. It is also imperative that the patient notifies a health care professional if they have any other type of allergies, this can include foods, dyes, preservatives or animals. If they take any non-prescription products, they must ensure they read the label or package ingredients.

Pediatric

The pediatric population has not been studied appropriately on the relationship of age to the effects of a topotecan injection. This means that safety and efficacy has not been established.

Geriatric

Elderly patients have been studied and these studies have not revealed any geriatric-specific problems that would limit the effectiveness of Topotecan injection in the elderly. Elderly patients are more likely to have age-related kidney problems, this may require an adjustment in the dose for patients receiving the injection.

Breastfeeding

For women who are breastfeeding, no adequate studies have been completed to outline infant risk. This is for the doctor to weigh the potential consequence before administering the medication.

Storage

It is important that Topotecan is kept in the correct storage, following these clear storage instructions and usage:

  • Store below 25°C – The vial must be kept in the vial in the outer carton, this will protect the vial from light.
  • Nature and contents of the container - Topotecan 1 mg/ml, 1 ml is supplied in 2 ml Type I amber glass vial and are closed with 13 mm flurotec rubber stopper and sealed with 13 mm aluminium flip off royal blue seal.
  • The infusion is in cartons containing 1 vial and 5 vials
  • Precautions for disposal and other handling - It is provided as a sterile concentrate containing 1 mg Topotecan in 1 ml solution and 4 mg Topotecan in 4 ml solution.
  • Parental products must be inspected visually for particulate matter and discoloration before administration.
  • Topotecan is a clear yellow color solution. If particles are observed, the product should not be administered.
  • Further dilution with either sodium chloride 9 mg/ml (0.9%) solution for injection or glucose 50 mg/ml (5%) solution for injection is required, to obtain a final concentration of between 25 and 50 micrograms/ml prior to administration to the patient.

As with all medicines, normal procedures for proper handling and disposal of anti-cancer medicinal products should be completed, such as:

  • All staff should be trained in reconstituting the product.
  • Pregnant staff should NOT be working with Topotecan
  • All handling of the product during reconstitution should be completed while wearing protective clothing, including gloves, goggles and mask.
  • Any items, including gloves, used for administration or cleaning should be placed in waste disposal bags for high-temperature incineration.
  • Any accidental contact with the skin or eyes should be treated as soon as possible with water. If irritation continues, then a Doctor should be consulted.
  • Any medicine that is unused or waste disposal should be disposed of in line with local requirements.

Summary

Topotecan is a beneficial drug that is used for the treatment of Cancer, a condition that is serious enough to warrant a drug of this nature.

It should be considered as one option for second-line treatment of advanced ovarian cancer, this is where the disease is initially resistant to first-line platinum-based combination therapy or has become resistant after successive courses of platinum-based combination therapy.

Treatment response should be checked by tumor markers and appropriate radiological techniques. If there is evidence of disease progression then treatment should be stopped.

Primarily used to treat patients with metastatic cancer of the ovary and small cell lung cancer, when the cancer has returned. It can be used when original treatment again is not recommended.

It can also be used in combination with cisplatin (another cancer medicine) to treat female patients with cancer of the cervix, if the cancer has returned following a course of radiotherapy or if the disease is at an advanced stage.

Topotecan belongs to the group ‘topoisomerase inhibitors’. It works by blocking an enzyme called topoisomerase I, which is involved in the division of DNA. By blocking the enzyme, these DNA strands break, which then goes onto prevent the cancer cells from dividing and eventually they die.

It does affect non-cancer cells, which causes side effects.

Studies have shown the effectiveness of Topotecan with an overall response rate of approximately 16%. In the core study, 21% of patients who received treatment responded, compared with 14% of patients who received paclitaxel. For lung cancer the response was 20%.

It has prolonged survival by 12 weeks and was effective as the standard combination chemotherapy. For patients with cervical cancer, receiving a combination of Topotecan and cisplatin prolonged survival by 9.4 months in comparison with patients on cisplatin who survived 6.5 months.

The impact on the patient, including the nature of the negative side effects, means that the Doctor should go through exactly how the treatment works and its consequence.

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Last Reviewed:
December 23, 2017
Last Updated:
December 22, 2017
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