Topotecan

What is Topotecan

Topotecan is a semi-synthetic, water-soluble derivative of camptothecin, a cytotoxic plant alkaloid isolated from the Chinese tree Camptotheca acuminata.

It is a topoisomerase I inhibitor that is FDA approved in capsule form as monotherapy for the treatment of small cell lung cancer (SCLC), and as an intravenous therapy for the treatment of ovarian cancer, cervical cancer, and SCLC.

Topotecan can cause severe myelosuppression; closely monitor complete blood counts (CBC). An interruption of therapy or dose adjustment may be necessary for patients with neutropenia, thrombocytopenia, or anemia.

Brand Name

Hycamtin

Indications

  1. cervical cancer
  2. non-small cell lung cancer (NSCLC)
  3. ovarian cancer
  4. rhabdomyosarcoma
  5. small cell lung cancer (SCLC)

For the treatment of patients with metastatic ovarian cancer with disease progression on or after initial or subsequent chemotherapy

Side Effects

  1. abdominal pain
  2. acute respiratory distress syndrome (ARDS)
  3. alopecia
  4. alopecia
  5. anaphylactoid reactions
  6. anemia
  7. anemia
  8. angioedema
  9. anorexia
  10. anorexia
  11. arthralgia
  12. asthenia
  13. asthenia
  14. back pain
  15. bleeding
  16. bone marrow suppression
  17. bone pain
  18. cardiac arrest
  19. chest pain (unspecified)
  20. chills
  21. constipation
  22. cough
  23. diarrhea
  24. diarrhea
  25. dysmenorrhea
  26. dyspareunia
  27. dyspnea
  28. elevated hepatic enzymes
  29. enterocolitis
  30. fatigue
  31. fatigue
  32. fever
  33. fever
  34. GI obstruction
  35. GI perforation
  36. headache
  37. hyperbilirubinemia
  38. hyperhidrosis
  39. hypoxia
  40. infection
  41. infection
  42. injection site reaction
  43. lethargy
  44. malaise
  45. myalgia
  46. nausea
  47. nausea
  48. neuropathic pain
  49. neutropenia
  50. neutropenia
  51. pelvic pain
  52. pharyngitis
  53. pleural effusion
  54. pneumonitis
  55. pruritus
  56. pulmonary embolism
  57. stomatitis
  58. thrombocytopenia
  59. thrombocytopenia
  60. typhlitis
  61. vomiting
  62. vomiting
  63. weight gain
  64. weight loss

Monitoring Parameters

  • CBC with differential
  • pregnancy testing
  • serum creatinine/BUN

Contraindications

  • abdominal pain
  • anemia
  • bone marrow suppression
  • breast-feeding
  • chronic lung disease (CLD)
  • colitis
  • contraception requirements
  • diarrhea
  • extravasation
  • fever
  • herpes infection
  • infection
  • infertility
  • lung cancer
  • male-mediated teratogenicity
  • neutropenia
  • pneumonitis
  • pregnancy
  • pregnancy testing
  • pulmonary disease
  • pulmonary fibrosis
  • radiation therapy
  • reproductive risk
  • serious hypersensitivity reactions or anaphylaxis
  • thrombocytopenia
  • varicella
  • viral infection

Interactions

  • Acalabrutinib
  • Amiodarone
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Atazanavir; Cobicistat
  • Brigatinib
  • Cabozantinib
  • Capmatinib
  • Clarithromycin
  • Cobicistat
  • Conivaptan
  • Cyclosporine
  • Daclatasvir
  • Darolutamide
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Dextromethorphan; Quinidine
  • Dronedarone
  • Elagolix
  • Elagolix; Estradiol; Norethindrone acetate
  • Elbasvir; Grazoprevir
  • Elexacaftor; tezacaftor; ivacaftor
  • Eliglustat
  • Eltrombopag
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Etravirine
  • Flibanserin
  • Fostamatinib
  • Glecaprevir; Pibrentasvir
  • grapefruit juice
  • Ibrutinib
  • Isavuconazonium
  • Istradefylline
  • Itraconazole
  • Ivacaftor
  • Ketoconazole
  • Lapatinib
  • Ledipasvir; Sofosbuvir
  • Leflunomide
  • Lomitapide
  • Lopinavir; Ritonavir
  • Lumacaftor; Ivacaftor
  • Mefloquine
  • Mifepristone
  • Nelfinavir
  • Neratinib
  • Ombitasvir; Paritaprevir; Ritonavir
  • Osimertinib
  • Palifermin
  • Penicillamine
  • Ponatinib
  • Posaconazole
  • Propafenone
  • Quinidine
  • Quinine
  • Ranolazine
  • Regorafenib
  • Ritonavir
  • Rolapitant
  • Safinamide
  • Sapropterin
  • Saquinavir
  • Sarecycline
  • Simeprevir
  • Sirolimus
  • Sofosbuvir; Velpatasvir
  • Sofosbuvir; Velpatasvir; Voxilaprevir
  • Sorafenib
  • Sulfasalazine
  • Tacrolimus
  • Tafamidis
  • Tedizolid
  • Temsirolimus
  • Teriflunomide
  • Tezacaftor; Ivacaftor
  • Ticagrelor
  • Tolvaptan
  • Trandolapril; Verapamil
  • Tuberculin Purified Protein Derivative, PPD
  • Tucatinib
  • Ulipristal
  • Vemurafenib
  • Venetoclax
  • Verapamil
  • Zonisamide
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