Cisplatin and topotecan chemotherapy
This information is about a chemotherapy treatment for cancer of the cervix and cancer of the ovary called called cisplatin and topotecan (CT).
You'll see your doctor regularly while you have this treatment so they can monitor the effects of the chemotherapy.
The drugs that are used
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This treatment involves two chemotherapy drugs: cisplatin and topotecan.
How treatment is given
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Cisplatin and topotecan chemotherapy treatment can usually be given to you as a day patient, but occasionally you may need to stay in hospital overnight. Before you start treatment you will need to have a blood test - either on the same day, or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. You will also have tests to check how well your kidneys are working as the chemotherapy can affect them. These may include collecting your urine for 24 hours, or having a specific blood test known as an EDTA test. If the results of your tests are normal, the pharmacy will prepare your chemotherapy drugs. This may take a couple of hours.
The nurse will insert a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful, but it shouldn’t last long. Some people have their chemotherapy given through a thin plastic tube inserted under the skin and into a vein near the collarbone (central line), or passed through a vein in the crook of your arm (PICC line). Your doctor or nurse will explain more about this to you.
You will be given some anti-sickness (anti-emetic) drugs. These are usually given by injection through the cannula or central or PICC line, which is connected to a drip (infusion). Some anti-sickness medicines are given as tablets.
Topotecan and cisplatin are both given to you separately as infusions. The topotecan (a colourless fluid) usually lasts for about 30 minutes and cisplatin (a colourless fluid) is usually given over 1-2 hours. You’ll be given extra fluids through a drip before and after the cisplatin. This can all take several hours, so you may need to stay in hospital overnight.
When your treatment is finished the cannula will be removed and you can go home. If you have a central or PICC line it will usually stay in place, ready for the next cycle of your chemotherapy. You will be shown how to look after the line.
You will be given a supply of anti-sickness drugs to take home with you. It’s important to take these as directed even if you aren't feeling sick. This is because some anti-sickness drugs are better at preventing sickness than stopping it once it starts.
How often treatment is given
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Your doctor may use the word ‘regimen’ (eg the CT regimen) when talking about your chemotherapy. This means the whole plan or schedule of your particular chemotherapy treatment.
On the first day of your treatment you will be given infusions of topotecan and cisplatin as described above. On the next two days (day two and day three) you will be given topotecan only. Or, you may be given topotecan a week later (on day eight) and then the following week (on day 15).
After this you will have a rest period with no chemotherapy until the next cycle of your treatment. Each cycle lasts for 21 days (three weeks).
After the rest period the same drugs will be given to you again to begin the next cycle of your treatment. You will be assessed during treatment and your doctor or nurse will advise you how many cycles of treatment you will require. Usually a minimum of four cycles are given.
Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described here won't affect everyone having this treatment.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you. If you notice any effects which aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
Cisplatin and topotecan can reduce the number of white blood cells, which help to fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you will be more prone to infections. A low white blood cell count is called neutropenia. This begins seven days after treatment and your resistance to infection is usually at its lowest 10-14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38ºC (100.4ºF)
you suddenly feel unwell, even with a normal temperature.
You will have a blood test before having more chemotherapy to check the number of white cells. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
Bruising and bleeding
Cisplatin and topotecan can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
Cisplatin and topotecan can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) or being sick (vomiting)
This is common and may begin soon after the treatment is given and last for a few days. Occasionally it may last longer. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight. You might find our section on eating well useful.
Your hair may fall out completely or just thin. This usually starts 3-4 weeks after starting treatment, although it may occur earlier. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will grow back once the treatment has finished. Your hair may grow back straighter, curlier, finer, or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss.
Feeling tired is a common side effect of chemotherapy especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with doing some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Your kidneys may be affected
This doesn't usually cause any symptoms, and the effect is generally mild. Rarely, it may cause permanent damage to the kidneys unless the treatment is stopped.
Before each treatment, your kidneys will be checked by a blood test. You’ll be given fluid through a drip (infusion) before and after the treatment to keep your kidneys working normally. You may be asked to measure and record what you drink and the amount of urine you pass. It’s important to tell your nurse or doctor if you pass less urine than usual.
If necessary, you may be given medicine to help you to pass urine. You may be asked to drink extra fluid before and after treatment. It's important to do this so let your doctor know if this is a problem, for example, if you are feeling sick.
Numbness or tingling in the hands or feet
This is due to the effect of cisplatin on the nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks.
Tell your doctor if you notice any numbness or tingling in your hands or feet. It's important to report your symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug.
This side effect usually improves slowly, a few months after the treatment has finished. Sometimes symptoms can persist, talk to your doctor if this happens.
Changes in hearing
Cisplatin may cause ringing in the ears (tinnitus) and you may lose the ability to hear some high-pitched sounds. Hearing loss can be more severe with higher doses and longer courses of treatment. Very occasionally your sense of balance may be affected. Any hearing loss, and balance changes if they occur, may be permanent. However tinnitus usually improves when treatment ends. Tell your doctor if you notice any loss of hearing or tinnitus.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Less common side effects
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Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Some people find that sucking on ice may be soothing. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections. You may find our section on mouth care during chemotherapy helpful
Cisplatin and topotecan can cause diarrhoea. This can usually be easily controlled with medicine but tell your doctor if it is severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, reddening of the face, dizziness, a headache, breathlessness, anxiety, and a feeling that you want to pass urine. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse about any side effects you have.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those you can buy in a shop or chemist, can be harmful to take when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant may be affected by having this treatment. It’s important to discuss fertility with your doctor before starting treatment.
It’s not advisable to become pregnant or father a child while having cisplatin and topotecan, as it may harm the developing baby. It’s important to use effective contraception while taking these drugs, and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This information is based on our cisplatin and topotecan fact sheet, which has been compiled using information from a number of reliable sources including:
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed October 2011).
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.