Topotecan (Hycamtin®)

What topotecan looks like Back to top

Topotecan is a powder that dissolves to form a colourless fluid.

Topotecan is also available as 0.25mg yellow and white capsules, and 1mg pink capsules. The capsules are only used to treat people with SCLC that has come back (relapsed) after initial treatment.

How it is given Back to top

Topotecan may be given as a drip (infusion) in one of the following ways:

• by injection into a vein (intravenously), through a fine tube inserted into a vein, usually in the back of your hand (cannula)
• through a fine, plastic tube inserted under the skin and into a vein near your collarbone (central line)
• into a fine tube inserted into a vein in the crook of your arm (PICC line).

The infusion takes approximately 30 minutes. Topotecan can also be taken as capsules that should be swallowed whole with a glass of water. The capsules can be taken with or without food. Your doctor may want you to take a combination of 0.25mg and 1mg capsules. You need to make sure you're taking the right dose and that you don't take too much or too little.

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.

Possible side effects Back to top

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 topotecan 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

Topotecan can reduce the number of white blood cells produced by the bone marrow, making you more prone to infection|. A low white blood cell count is called neutropenia.

Neutropenia can begin seven days after treatment, and your resistance to infection usually reaches its lowest point around 10-12 days after chemotherapy. The number of your white blood cells will then increase steadily over the next seven days, and will 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 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

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 may need to have a platelet transfusion| if your platelet count is low.

Anaemia

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) 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.

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|.

Hair loss

Your hair may thin or fall out completely. 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 hair in other areas of the body|. 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|.

Tiredness (fatigue)

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 Back to top

Sore mouth

Your mouth may become sore or dry|, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicines to prevent or clear mouth infections.

Diarrhoea

This can usually be easily controlled with medicine, but tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea|.

Additional information Back to top

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.

Other medicines

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|.

Fertility

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.

Contraception

It's not advisable to become pregnant or father a child while taking topotecan 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.

Non-cancer admission

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.

Emergency contacts

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.

Things to remember about topotecan capsules Back to top

• It's important to take your capsules at the right times as directed by your doctor.
• Take the capsule whole with water. Don't open the capsules. 
• Always tell any doctors treating you for non-cancerous conditions that you're taking a course of chemotherapy capsules that shouldn't be stopped or restarted without the advice of your cancer specialist.
• Keep the capsules in their original packaging, and store them in the fridge away from direct sunlight.
• Keep the capsules in a safe place and out of the reach of children.
• If your doctor decides to stop the treatment, return any remaining capsules to the pharmacist. Don't flush them down the toilet or throw them away.
• If you forget to take a capsule, don't take a double dose. Let your doctor know and keep to your regular dose schedule.
• If you're sick just after taking the capsules, let your doctor know. You may need to take another dose. Don't take another capsule without telling your doctor first.

References Back to top

This section is based on our topotecan 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.