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Thiotepa (Tepadina)

Thiotepa is a chemotherapy drug that has the brand name Tepadina. It is a treatment for many different types of cancer.

Thiotepa is also used to prepare people for a bone marrow transplant. 

How it works

Thiotepa is a type of drug called an alkylating agent. It works by sticking to 1 of the cancer cell's DNA strands. Then the cell can't divide into 2 new cells. 

The DNA is the genetic code that is in the heart of all animal and plant cells. It controls everything the cell does. 

How you have it

Thiotepa is a clear liquid that you have into your bloodstream (intravenously). It usually takes 2 to 4 hours each time. 

Drugs into your bloodstream

You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

When you have it

The treatment plan for thiotepa depends on which type of cancer you have. 

You have it every 12 hours or 24 hours. You might have up to 5 days of treatment. 

Tests during treatment

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.

When to contact your team

Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your advice line or your doctor or nurse immediately if you have signs of infection, such as a temperature above 37.5C or below 36C, or if you develop a severe skin reaction. Signs of a severe skin reaction include peeling or blistering of the skin.

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nosebleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia).

Tiredness and weakness (fatigue) during and after treatment

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Headaches and dizziness

Let your doctor or nurse know if you have headaches. They can give you painkillers. Don’t drive or operate heavy machinery if you feel dizzy.

Eye problems

You might have eye problems including blurred vision, sore, red, itchy, dry eyes (conjunctivitis) or an infection. Tell your doctor or nurse if you have this. They can give you eye drops or other medication to help. 

Fits (seizures)

Tell your doctor if you have any fits, twitching or jerking of your limbs. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.

Numbness and tingling in the fingers and toes

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment.

Diarrhoea 

Contact your advice line if you have diarrhoea, that is 4 loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid, or if it carries on for more than 3 days. Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty of liquid to replace the fluid lost.

Mouth sores and ulcers

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Tummy (abdominal) pain

Tell your doctor or nurse if you have this. They may give you medicine to help. 

Loss of appetite

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can all put you off food and drinks.

High blood sugar levels

You have regular blood and urine tests to check this. If you have diabetes you may need to check your blood sugar levels more often than usual. 

Skin problems

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will grow back once treatment has finished. But it is likely to be softer. And it may grow back a different colour or be curlier than before. 

Back, joint or muscle pain

You might feel some pain from your muscles and joints. Speak to your doctor or nurse about what painkillers you can take to help with this.

Lung problems

You might develop a cough or breathing problems. This could be due to infection, such as pneumonia or inflammation of the lungs (pneumonitis). Let your doctor or nurse know straight away if you suddenly become breathless or develop a cough.

A less common side effect is fluid on the lung. This also can cause breathlessness. 

Yellowing of the skin and eyes

This is called jaundice. It is caused by high levels of bile pigments in the blood. Let your doctor or nurse know straight away if you have this.

Hearing changes

You might have some hearing loss, especially with high pitched sounds. You might also have some ringing in your ears (tinnitus). Tell your doctor or nurse if you notice any changes.

High blood pressure

Tell your doctor or nurse if you have headaches, nose bleeds, blurred or double vision or shortness of breath. Your nurse will check your blood pressure regularly.

Weight gain

You may gain weight while having this treatment. You may be able to control it with diet and exercise. Tell your doctor or nurse if you are finding it difficult to control your weight. 

Fluid build up

A build up of fluid may cause swelling in your arms, hands, ankles, legs, face and other parts of the body. Contact your doctor if this happens to you.

Inflammation around the drip site

Tell your nurse straight away if you notice any signs of redness, swelling or leaking at your drip site.

Blood in the urine

You might have pain when you pass urine. Or you may see blood when you pass urine. This is caused by inflammation of the bladder. Let your doctor know if this happens. 

You should drink 8 to 12 cups of fluid a day to try to prevent this.

Difficulty remembering things

You might have some difficulty remembering while having this treatment. Talk to your doctor or nurse if this happens.

Changes to some hormone levels 

Some people make less amounts of particular hormones. This may make you feel tired and less able to react to things as you would usually. You may also have a low sex drive or put on weight. You have regular blood tests to check your hormone levels. 

Confusion

You or the people around you may notice that you feel confused. Tell your doctor or nurse if this happens.

Inflammation of the bowel 

Inflammation of the bowel can cause abdominal pain, bloating or diarrhoea. Speak to your doctor if you have these symptoms.

Inflammation of the food pipe (oesophagus) 

This can cause a number of symptoms including feeling sick, taste changes, chest pain, bloating, burping and heart burn. Tell your doctor or nurse if you suddenly have any of these.

Changes to the heart

You may have changes to the way your heart works. Your heart beat may be irregular. 

Less common side effects can be a very fast heart beat and heart attack. A rare side effect can be inflammation of the heart muscle. 

Pain where the cancer is

You might have pain where your cancer is. Tell your doctor or nurse if you do. 

Occasional side effects

Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them. They include:

  • constipation
  • general pain
  • allergic reaction
  • anxiety
  • changes to the way the kidneys work
  • clouding of the eye lens (cataract)
  • bleeding in the brain (stroke)
  • bowel blockage
  • bleeding into the stomach
  • muscle weakness and loss of coordination
  • cough
  • pain passing urine
  • passing urine less often than usual
  • an increased risk of getting another type of cancer in the future

Rare side effects

Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • inflammation, blistering or peeling of the skin
  • stomach ulcer

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know

Other medicines, food and drink 

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment.

Talk to your doctor or nurse about effective contraception you can use during treatment. Ask how long you should use it before starting treatment and after treatment has finished.

Fertility

You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.

Breastfeeding

It is unknown whether or not this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Immunisation

Don’t have immunisations with live vaccines while you’re having treatment and for at least 6 months afterwards.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)
  • be in contact with other people who've had live vaccines as injections

Avoid close contact with people who’ve recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So, avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened. 

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

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