Thiotepa is a chemotherapy drug given to treat different types of cancer, including ovarian and bladder cancer, and some types of lymphoma. This information should ideally be read with our general information on chemotherapy and your type of cancer.
What thiotepa looks like
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Thiotepa is a colourless fluid.
Thiotepa may be given in one of the following ways:
by injection into a muscle (intramuscularly)
as a drip (infusion) through a fine tube (cannula) placed into the vein, usually in the back of the hand
through a fine, plastic tube that is inserted under the skin and into a vein near the collarbone (central line)
into a fine tube that is inserted into a vein in the crook of your arm (PICC line)
as an injection into a vein (intravenously) through a cannula or line directly into the bladder (intravesically)
by injection into the fluid around the spinal cord through a lumbar puncture (intrathecally) or an Ommaya reservoir (a flat plastic bubble inserted into an area beneath the scalp).
Only specially trained staff are able to give intrathecal thiotepa, so it may be given in a different part of your hospital and by different staff from the rest of your chemotherapy. In some situations, you may have to travel to a different hospital to have intrathecal thiotepa.
Chemotherapy is usually given as a course of several sessions (cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer you're being treated for. Your nurse or doctor will discuss your treatment plan with you.
Before you begin your treatment your doctor will arrange for you to have blood tests. You'll usually be given anti-sickness drugs before and/or during your treatment.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described below won't affect everyone who has thiotepa and may be different if you're having more than one type of chemotherapy drug.
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 that aren't listed below, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
Thiotepa can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you'll be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment, and your resistance to infection is usually at its lowest 14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal over 21-28 days.
Contact your doctor or the hospital straight away if:
your temperature goes above 38˚C (100.4˚F)
you suddenly feel unwell even with a normal temperature.
You'll have a blood test before having more chemotherapy, to make sure the number of white blood cells has recovered. Occasionally, it may be necessary to delay your treatment if the number of your blood cells (blood count) is still low.
Bruising and bleeding
Thiotepa 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 may need to have a platelet transfusion if your platelet count is low.
Thiotepa 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) and being sick (vomiting)
This may begin soon after the treatment is given and can last for a few days. 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.
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 some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Less common side effects
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Thiotepa can cause pain at the place where the injection is given or along the vein. If you feel pain, tell your nurse or doctor straight away so that they can check the site. They may give the drug more slowly or flush it through with more fluid to reduce pain.
Thiotepa can cause a rash, which may be itchy. Your doctor can prescribe medicine to help with this. Your skin may darken due to excess production of pigment. It usually returns to normal a few months after the treatment has finished.
This is rare, but your hair may thin or occasionally fall out completely. If this happens, it usually begins about 3-4 weeks after starting treatment, although it may occur earlier. This is temporary and your hair will start to 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.
Signs of an allergic reaction include skin rashes and itching, a high temperature (fever), shivering, reddening of the face, dizziness, a headache, breathlessness, anxiety, and a feeling that you want to pass urine. You'll be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse about any side effects you have.
Long-term bone marrow changes
Long-term thiotepa treatment may permanently damage the bone marrow. This can affect the production of healthy blood cells and may lead to the development of myelodysplasia (a condition affecting the function of the bone marrow) or leukaemia (cancer of the white blood cells). The risks of long-term damage are outweighed by the benefits of the drug. Your doctor can discuss this with you further.
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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The side effects mentioned above are most likely to occur if thiotepa is given into a vein (intravenously). The other ways of giving thiotepa are less likely to cause side effects.
If thiotepa is given into the bladder, it may irritate the bladder lining. This may mean you feel the urge to pass urine more often (cystitis). Your doctor can prescribe medicine to reduce this feeling. Other side effects are very rare when thiotepa is given in this way.
If thiotepa is given into the fluid around the spinal cord, it can temporarily cause dizziness and headaches.
Thiotepa eye drops may be used to treat a non-cancerous condition of the eye. The eye drops may cause some irritation of the skin around the eye. There may also be loss of colour in the skin in this area. Other side effects do not occur.
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're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child 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 taking thiotepa as it may harm the developing baby. It's important to use effective contraception while taking this drug and for at least a few months afterwards. You can discuss this with your doctor or nurse.
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're 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.
Very rarely, thiotepa may cause a second cancer to develop years later. Your nurse or doctor can discuss this with you.
This section is based on our thiotepa fact sheet, which has been compiled using information from a number of reliable sources, including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
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.