Treosulfan

Treosulfan is a chemotherapy drug used to treat ovarian cancer. You may also have it as high dose treatment for leukaemia before a donor bone marrow or stem cell transplant. Treosulfan is an alkylating agent. These drugs work by sticking to one of the cancer cell's DNA strands. The cell cannot then divide into 2 new cells.

Treosulfan comes as capsules in 250mg strength. Swallow the capsules whole with plenty of water.  It is very important that you take tablets according to the instructions your doctor or pharmacist gave you. Whether you have a full or empty stomach, for example, can affect how much of a drug gets into your bloodstream. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.

Treosulfan also comes as a clear fluid. You have it into your bloodstream (intravenously). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

You may have treosulfan by injection straight into the tummy (abdomen). This last route is called intraperitoneal injection. 

You usually have treosulfan chemotherapy as a course of several cycles of treatment. The treatment plan depends on which type of cancer you have. There is more about how doctors plan chemotherapy on CancerHelp UK.

Treosulfan side effects 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 occurs in about half the people treated but is usually mild and easily controlled with anti-sickness injections and tablets – tell your doctor or nurse if your sickness is not controlled as you can try other anti sickness drugs
• Bronze colouring to the skin in up to 1 in 3 people (30%) – this should go back to normal within a few months of treatment finishing
• Hair loss or hair thinning happens in about 1 in 6 people (15%) although complete hair loss is rare - your hair will grow back when your treatment is finished
• Loss of fertility – you may not be able to get pregnant or father a child after treatment with treosulfan, so it is important to talk to your doctor about your fertility before starting treatment if having a baby is important to you
• Women may stop having periods (amenorrhoea), but this may only be temporary
• Treosulfan may harm a developing baby so it is not advisable to become pregnant or father a child if you are having this drug – talk about contraception with your doctor before having the treatment if there is any chance of you or your partner becoming pregnant
• You should not breastfeed while having this drug as it may come through in the breast milk

While you are having treosulfan by injection into a vein, there is a possibility that it could leak into the tissues of the arm around the injection site and cause damage. It is important to tell the nurse or doctor if you have any stinging or burning around the injection site, leakage of fluid, redness or swelling around the injection area after treatment has finished.

Fewer than 1 in 100 people have these.

• A skin rash
• Blood in your urine – drink plenty of fluids on the day of your treatment and for the next 24 hours, to flush the drug through your kidneys and bladder
• Scarring in the lungs that may cause breathlessness and a cough months or years after treatment

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.