Topotecan (Hycamtin)

Topotecan was originally developed from the wood of a Chinese tree. It is also known by its brand name, Hycamtin. It is a type of chemotherapy drug called a topoisomerase 1 inhibitor. It works by blocking an enzyme called topoisomerase 1. This enzyme helps to separate and repair the DNA in cells when they divide. Cancer cells need to make and repair DNA in order to grow and multiply. Blocking the action of this enzyme damages the DNA and so the cells die. It is a treatment for

• Ovarian cancer
• Small cell lung cancer
• Acute myeloid leukaemia (rarely)
• Cervical cancer

You usually have topotecan therapy as a course of several cycles of treatment. It is a clear liquid that you have through a drip (infusion) into a vein. You have the infusion once a day for 5 days. It takes about half an hour each time. You have the 5 day treatment every 3 weeks. It may be possible for your consultant to arrange for a nurse to come to your home to give this treatment. If the nurse comes to your home you don't have to travel to the hospital every day for 5 days. If your doctor doesn't suggest home treatment, you can ask. Topotecan is also available as a capsule to treat small cell lung cancer. You take it for 5 days every 3 weeks.

Your doctor is not likely to recommend topotecan if you

• Are not well enough to spend more than half the day up and about
• Have significant kidney or liver problems
• Have a blockage of the bowel

The side effects of topotecan are listed below. You can use the links to find out more about each side effect or go to the cancer drug side effects section.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue during and after treatment – most people find their energy levels are back to normal from 6 months to a year after their treatment finishes
• Feeling or being sick can be quite severe and happens in up to up to 7 out of 10 people (70%) – it can usually be kept under control with anti sickness medicines so do tell your doctor if you are still being sick because there will be others you can try
• Hair loss or thinning happens in about 6 out of 10 people (60%) but 4 out of 10 (40%) people have complete hair loss – this usually begins about 3 to 4 weeks after your treatment starts but is only temporary and your hair will grow back
• Diarrhoea happens to about 4 out of every 10 people (40%) and can be severe – drink plenty of fluids and tell your doctor if it lasts more than a couple of days
• Constipation occurs in 2 to 4 out of every 10 people (20 to 40%) treated – if you are constipated for more than 3 days, tell your doctor or nurse
• About 3 out of 10 people (30%) treated have a fever (high temperature) – you may have other flu like symptoms, such as a headache, weakness, joint pain and muscle aches
• A sore mouth or mouth ulcers happens in up to 3 in every 10 people (30%) treated – tell your doctor, who can give you medicines to help prevent infection and relieve pain and soreness
• Loss of appetite occurs in about 2 out of every 10 people (20%) treated
• This drug may harm a developing baby so it is not advisable to become pregnant or father a child if you are having it – talk about contraception to your doctor before having the treatment if there is any chance you or your partner could become pregnant

Some people have difficulty breathing – this happens in only 1 person in 10 (10%) and you must tell your doctor if you have this effect.

Fewer than 1 in 100 people have these.

• Pain in the abdomen (tummy)
• Headache
• A skin rash
• Loss of fertility – you may not be able to get pregnant or father a child after treatment with this drug, so if having a baby is important to you, it is important to talk to your doctor about fertility before starting treatment
• Women may stop having periods (amenorrhoea) but this may only be temporary

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.