Drug Action
Topotecan inhibits topoisomerase I, an enzyme involved in DNA replication.
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Drug reference
Topotecan inhibits topoisomerase I, an enzyme involved in DNA replication.
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Metastatic ovarian cancer when first-line or subsequent treatment has failed | Treatment of recurrent carcinoma of the cervix, after radiotherapy, and for patients with stage IVB disease (in combination with cisplatin) ▶BY INTRAVENOUS INFUSION ▶Adult: (consult product literature or local protocols) Relapsed small-cell lung cancer when retreatment with the first-line regimen is considered inappropriate ▶BY INTRAVENOUS INFUSION, OR BY MOUTH ▶Adult: (consult product literature or local protocols)
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NICE decisions ▶Topotecan for the treatment of recurrent and stage IVB cervical cancer (October 2009) NICE TA183 Topotecan in combination with cisplatin is recommended as a treatment option for recurrent or stage IVB cervical cancer in patients who have not previously received cisplatin. www.nice.org.uk/guidance/ta183 ▶Topotecan for the treatment of relapsed small-cell lung cancer (November 2009) NICE TA184 Oral topotecan is recommended as an option for treatment in patients with relapsed small-cell lung cancer only if re- treatment with the first-line regimen is not considered appropriate, and the combination of cyclophosphamide, doxorubicin and vincristine is contra-indicated. Intravenous topotecan is not recommended for people with relapsed small-cell lung cancer. www.nice.org.uk/guidance/ta184 ▶Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for treating recurrent ovarian cancer (April 2016) NICE TA389 Topotecan is not recommended for treating first recurrence of platinum-sensitive ovarian cancer, recurrent platinum-resistant ovarian cancer, or platinum-refractory ovarian cancer. Patients currently receiving topotecan should have the option to continue their treatment until they or their clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta389 Scottish Medicines Consortium (SMC) decisions The Scottish Medicines Consortium has advised (December 2007) that topotecan (Hycamtin ®) is accepted for restricted use in combination with cisplatin for treatment of recurrent carcinoma of the cervix after radiotherapy and for stage IVB disease; it is restricted to patients who have Immune system and malignant disease not previously received cisplatin treatment.
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RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES See Cytotoxic drugs p. 938.
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→Appendix 1: topotecan
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▶Common or very common Alopecia. anaemia. appetite decreased. asthenia. colitis neutropenic. constipation. diarrhoea. fever. gastrointestinal discomfort. hyperbilirubinaemia. hypersensitivity. infection. leucopenia. malaise. mucositis. nausea. neutropenia. pancytopenia. sepsis. skin reactions. thrombocytopenia. vomiting ▶Rare or very rare Angioedema. interstitial lung disease ▶Frequency not known Bone marrow depression (dose- limiting). haemorrhage
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Contraceptive advice required, see Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Avoid (teratogenicity and fetal loss in animal studies). See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Discontinue breast-feeding.
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Manufacturer advises avoid in severe impairment (limited information available).
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Avoid infusion if creatinine clearance less than 20 mL/minute. Avoid oral route if creatinine clearance less than 60 mL/minute. Dose adjustments Reduce dose.
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There can be variation in the licensing of different medicines containing the same drug. Solution for infusion ▶Topotecan (Non-proprietary) Topotecan (as Topotecan hydrochloride) 1 mg per 1 ml Topotecan 4mg/4ml concentrate for solution for infusion vials | 5 vial P £1,453.10 (Hospital only) Powder for solution for infusion ▶Hycamtin (Novartis Pharmaceuticals UK Ltd) Topotecan (as Topotecan hydrochloride) 1 mg Hycamtin 1mg powder for concentrate for solution for infusion vials | 1 vial P £97.65 Topotecan (as Topotecan hydrochloride) 4 mg Hycamtin 4mg powder for concentrate for solution for infusion vials | 1 vial P £348.76 ▶Potactasol (Actavis UK Ltd) Topotecan (as Topotecan hydrochloride) 4 mg Potactasol 4mg powder for concentrate for solution for infusion vials | 1 vial P £290.00 (Hospital only) Capsule CAUTIONARY AND ADVISORY LABELS 25 ▶Hycamtin (Novartis Pharmaceuticals UK Ltd) Topotecan (as Topotecan hydrochloride) 250 microgram Hycamtin 0.25mg capsules | 10 capsule P £75.00 Topotecan (as Topotecan hydrochloride) 1 mg Hycamtin 1mg capsules | 10 capsule P £360.00 ANTINEOPLASTIC DRUGS › VINCA ALKALOIDS
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(consult product literature or local protocols)
First-line fragment. Read the complete Indications and Dose section above.
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(consult product literature or local protocols)
First-line fragment. Read the complete Indications and Dose section above.
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