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Topotecan is a cancer treatment drug that kills or limits the growth of cancer cells. It is used in the treatment of small cell lung cancer and metastatic ovarian carcinoma, and in combination with cisplatin with carcinoma of the cervix.1. What is Topotecan?
Topotecan is a drug that fights cancer by killing or limiting the growth of cancer cells. Topotecan is used in the treatment of recurrent small cell lung cancer (SCLC) and metastatic ovarian carcinoma when initial treatment regimens have not been effective.
Specifically, for the treatment of small cell lung cancer and ovarian carcinoma, Topotecan is used after the failure of an initial course of chemotherapy to be ineffective. For cervical carcinoma, topotecan is used in combination with cisplatin to treat patients with recurrence after radiotherapy/surgery at stage 4B by cytology.
2. Dosage and how to use Topotecan
2.1. Small cell lung and ovarian carcinoma Initial dose: Administer 1.5mg/m2 body surface area by intravenous infusion 30 minutes daily, each course lasts 5 consecutive days, minimum of 4 sessions , the interval between batches is 21 days. Subsequent doses: If patient is not well tolerated, neutrophil count < 1 x 109/L, platelet count < 100 x 109/L, and hemoglobin level < 9 g/dl, change course Treatment is by using topotecan in combination with other drugs or reducing the dose used to maintain neutrophil counts. The dose is reduced to 1.25 mg/m2/day when neutrophil count <0.5 x 109/L) persists for more than 7 days, severe leukopenia with fever or infection, delayed treatment due to neutropenia. If leukocyte count, platelet count falls below 25 x 109/L, the dose should be reduced by 0.25 mg/m2/day to 1.25 mg/m2/day. Topotecan was discontinued when the dose had been reduced to 1.0 mg/m2/day and further dose reductions were still needed to control adverse events. 2.2. Cervical carcinoma Initial dose: Specify topotecan at dose of 0.75 mg/m2/day, intravenous infusion for 30 minutes for 3 days, Cisplatin dose of 50 mg/m2/day given intravenously on day 4. Each course lasts 4 days, treatment is 6 consecutive sessions, each session is 21 days apart or until disease progression. Subsequent doses: If patient is not well tolerated, neutrophil count < 1 x 109/L, platelet count < 100 x 109/L, and hemoglobin level < 9 g/dl, change course treated by reducing the dose. Neutrophil counts fall to <0.5 x 109/L for 7 days or more, or severe leukopenia with fever or infection, or those with delayed treatment due to leukopenia, platelet counts If the dose falls below 25 x 109/L, the dose should be reduced to 0.60 mg/m2/day (even 0.45 mg/m2/day if necessary). 2.3. Treatment of patients with renal insufficiency Monotherapy (carcinoma of the ovary and small cell lung cancer): Not recommended for patients with severe renal impairment (creatinine clearance <20 ml) /minute). For patients with creatinine clearance between 20 and 39 ml/min, the dose is 0.75 mg/m2/day for 5 consecutive days.
Combination therapy (cervical carcinoma): Topotecan in combination with cisplatin in the treatment of cervical cancer is indicated only when serum creatinine is less than or equal to 1.5 mg/dl. If serum creatinine exceeds 1.5 mg/dl, the need to continue or reduce the dose of cisplatin should be reconsidered. Topotecan alone after discontinuation of cisplatin does not have adequate data on its efficacy in patients with cervical cancer.
2.4. Treatment for people with liver failure For a small number of patients with liver failure with serum bilirubin levels of 1.5-10 mg/dl, topotecan is used at a dose of 1.5 mg/m2/day. There are no specific studies on the use of topotecan in patients with severe hepatic impairment with serum bilirubin levels ≥10 mg/dl due to cirrhosis.
3. Contraindications of Topotecan
Topotecan should not be used by pregnant and lactating women, people who are allergic to its ingredients, and people with bone marrow failure (basal neutrophil count <1.5 x 109/L or platelet count <100 x 109/L).
4. Topotecan side effects
Common side effects: Rash, loss of appetite, nausea, vomiting, diarrhea, constipation, abdominal pain, alopecia areata, sepsis, febrile neutropenia, neutropenia, decreased urination anemia, anemia. Uncommon side effects: Hyperbilirubinemia, itching. Rare side effects: Anaphylaxis, angioedema, urticaria, interstitial lung disease, extravasation. Frequency not known: Severe bleeding associated with thrombocytopenia, gastrointestinal perforation, mucositis.
5. Notes when using Topotecan
Topotecan toxicity to blood cells needs to be determined regularly. Myelosuppression may occur during the use of Topotecan causing sepsis. Topotecan-induced leukopenia can cause colitis, leukopenia with fever, neutropenia, and a corresponding pattern of abdominal pain, and death has been reported.
Topotecan has been associated with interstitial lung disease (cough, fever, shortness of breath, hypoxia), which can be fatal. High risk occurs in people with a history of interstitial lung disease, pulmonary fibrosis, lung cancer, thoracic exposure to radiation, the use of toxic gases or colony-stimulating factors.
For patients with poor response, often with symptoms of fever, infection and sepsis, it is necessary to be continuously checked to provide an appropriate treatment plan, limiting side effects for the patient. Topotecan is a cancer treatment drug that kills or limits the growth of cancer cells. It is used in the treatment of small cell lung cancer and metastatic ovarian carcinoma, and in combination with cisplatin with carcinoma of the cervix.
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