Irinotecan

Trade names:  Camptosar®  ^.

Other names:  Camptothecin-11, CPT-11

mhp.ooo uses generic names in all drug descriptions. Camptosar is the trade name for irinotecan. Camptothecin-11 and CPT-11 are other names for irinotecan. In some cases, healthcare professionals may use the brand name camptosar or other names camptothecin-11 or CPT-11 when referring to the generic name irinotecan.

Type of medication:  Irinotecan is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This drug is classified as a "plant alkaloid" and "topoisomerase I inhibitor. (For details, see the section" How this drug works "below).

What irinotecan is used for:

• Metastatic colon or rectal cancer

Note.    If a drug has been approved for a single use, doctors may decide to use the same drug for other problems if they think it might be helpful.

How is irinotecan administered:

• This medication is given through a vein (intravenous, intravenous).
• There is no tablet form for this medication.
• Irinotecan is irritating. An irritant is a chemical that can inflame the vein through which it is injected. If the medication comes out of a vein, it can cause tissue damage. The nurse or doctor who prescribes this medication must be carefully trained. If you experience pain or redness or swelling at the IV site while taking irinotecan, tell your doctor right away. 
• The amount of irinotecan you get depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose and schedule.

Side effects:

Important things to remember about the side effects of irinotecan:

• Most people do not experience all of these side effects.
• Side effects are often predictable in terms of their onset and duration.
• Side effects are almost always reversible and go away after treatment is completed.
• There are many ways to minimize or prevent side effects.
• There is no relationship between the presence or severity of side effects and the effectiveness of a drug.
• Irinotecan side effects and their severity depend on how much of the drug is given. In other words, high doses can cause more serious side effects.

The following side effects are common in patients taking irinotecan (occurring in more than 30%):

• Diarrhea; two types: early and late forms.
• Early diarrhea: occurs within 24 hours after taking the drug, accompanied by symptoms of a runny nose, increased salivation, lacrimation, sweating, redness, abdominal cramps. (This can happen while taking the drug. If so, tell your healthcare provider right away. Medication can be given to stop and / or reduce this early side effect).
• Late diarrhea: occurs more than 24 hours after taking the drug, usually peaks about 11 days after treatment. Because of concerns about dehydration and electrolyte imbalances in diarrhea, it is important to keep in touch with health care providers for follow-up and advice on dietary changes and medication. 
• Nausea and vomiting.
• Weakness.
• Low white blood cell count. (This can increase the risk of infection).
• Low red blood cell count (anemia).

Nadir:  stands for low point, nadir is the point in time between chemotherapy cycles at which you have low blood counts.

Start:  10 days
Nadir:  14-16 days
Cooldown:   21-28 days

• Hair loss
• Poor appetite
• Heat
• Weight loss

These side effects are less common side effects (occurring in about 10-29%) of patients receiving irinotecan:

• Constipation
• Dyspnea
• Insomnia (see sleep problems)
• Cough
• Headache
• Dehydration
• Chills (see Flu Symptoms)
• Skin rash (see Skin Reaction)
• Flatulence (see abdominal pain)
• Face wash during infusion
• Mouth ulcers
• Heartburn
• Swelling of the feet and ankles

Not all side effects are listed above. Some of them, which are rare (occurring in less than 10% of patients), are not listed here. However, you should always tell your doctor if you experience any unusual symptoms.

When to contact your doctor or healthcare provider:

Call  your doctor right away, day or night, if you experience any of the following symptoms:

• Fever of 100.4 ° F (38 ° C) or higher, chills (possible signs of infection)
• Fainting, dizziness, lightheadedness, dark colored urine (symptoms of dehydration)

The following symptoms require medical attention but are not urgent. Contact your doctor  within 24 hours after  you notice any of the following:

• Diarrhea (4-6 episodes in 24 hours) despite use of antidiarrheal drugs and dietary changes.
• Nausea (interferes with eating and does not go away with prescribed medication).
• Vomiting (more than 4-5 times in 24 hours)
• Severe fatigue (inability to practice self-care)
• Mouth sores (painful redness, swelling, or sores)

Always tell your doctor if you experience any unusual symptoms.

Precautionary measures:

• Before starting irinotecan treatment, be sure to tell your doctor about any other medicines you are taking (including prescription, over-the-counter, vitamins, herbal medicines, etc.). Do not take aspirin and products that contain aspirin unless directed by your doctor.
• Do not get any vaccinations or vaccines while taking irinotecan without your doctor's approval.
• In general, the use of laxatives or stool stimulants should be avoided because of the potential for worsening diarrhea. Discuss the use of a laxative with your doctor.
• Tell your doctor if you are or may be pregnant before starting this treatment. Pregnancy category D (irinotecan) can be hazardous to the fetus. Pregnant or become pregnant women should be warned of the potential hazard to the fetus).
• For both men and women: Do not conceive (get pregnant) while taking irinotecan. Barrier methods of contraception such as condoms are recommended. Talk with your doctor about when you can safely get pregnant or conceive after therapy.
• Do not breastfeed while you are taking this medicine.

Self-care tips:

• If you have redness or pain at the infusion site, apply ice and tell your doctor immediately.
• Drink at least two to three liters of fluid every 24 hours, unless instructed otherwise.
• Follow the antidiarrheal medication regimen prescribed by your healthcare professional. 
• Eat foods that can help reduce diarrhea (see Side Effect Management - Diarrhea).
• To reduce nausea, take your nausea medication as directed by your doctor and eat small meals often. Lozenges and chewing gum may also help. 
• You may be at risk of infection, so try to avoid crowds or people who are sick or unwell and tell your doctor immediately if you have a fever or any other sign of infection.
• Wash your hands often.
• To help heal / prevent mouth ulcers, use a soft toothbrush and rinse it three times daily with 1/2 to 1 teaspoon of baking soda and / or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
• Avoid sun exposure. Use SPF 15 (or higher) sunscreen and protective clothing.
• In general, drinking alcoholic beverages should be minimized or avoided altogether. You should discuss this with your doctor.
• Ample time to rest. 
• Maintain proper nutrition.
• If you experience symptoms or side effects, be sure to discuss them with your healthcare provider. They can prescribe medications and / or offer other effective solutions to address such problems.

Monitoring and testing:

You will be checked regularly by your healthcare provider while you are taking irinotecan to monitor side effects and check your response to therapy. Your doctor will also order periodic blood tests to monitor your complete blood count (CBC) as well as the function of other organs (such as the kidneys and liver).   

How irinotecan works:

Cancer tumors are characterized by cell division that is no longer controlled as in normal tissue. "Normal" cells stop dividing upon contact with similar cells, a mechanism known as contact inhibition. Cancer cells lose this ability. Cancer cells no longer have the usual checks and balances that control and limit cell division. The process of cell division, whether normal or malignant, proceeds through the cell cycle. The cell cycle moves from the resting phase to the phases of active growth, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to stop cell division. Typically, drugs work by damaging the RNA or DNA that tells the cell how to replicate itself as it divides. If cells cannot divide, they die. The faster cells divide, the more likely the chemotherapy will kill the cells, leading to shrinking of the tumor. They also induce cell suicide (suicide or apoptosis).

Chemotherapy drugs that affect cells only when they divide are called cell cycle specific. Chemotherapy drugs that target cells while they are at rest are called non-cell cycle specific. Chemotherapy scheduling is determined by the type of cells, the rate at which they divide, and the length of time the drug can be effective. This is why chemotherapy is usually given in cycles.

Chemotherapy is most effective at killing rapidly dividing cells. Unfortunately, chemotherapy doesn't know the difference between cancer cells and normal cells. "Normal" cells will grow and become healthy, but at the same time, side effects will occur. The “normal” cells most commonly affected by chemotherapy are blood cells, cells in the mouth, stomach, and intestines, and hair follicles; resulting in low blood counts, mouth ulcers, nausea, diarrhea, and / or hair loss. Different drugs can affect different parts of the body.

Irinotecan belongs to a class of chemotherapy drugs called herbal alkaloids. Plant alkaloids are produced from plants. The periwinkle alkaloids are produced from the plant periwinkle (pink catharanthus). Taxanes are made from the bark of the Pacific yew (taxus). Vinca alkaloids and taxanes are also known as anti-microtubule agents. Podophyllotoxins are obtained from the May apple tree. Camptothecan analogs are derived from the Asian lucky tree (Camptotheca acuminata). Podophyllotoxins and camptothecan analogs are also known as topoisomerase inhibitors. Plant alkaloids are cell cycle specific. This means that they attack cells during different phases of division.

• Vinca alkaloids:  vincristine, vinblastine and vinorelbine.
• Taxanes:    paclitaxel and docetaxel.
• Podophyllotoxins:    etoposide and tenisopide.
• Camptothecan analogs:  Irinotecan and Topotecan.

Topoisomerase inhibitors (such as ironotecan) are drugs that interfere with the action of topoisomerase enzymes (topoisomerase I and II). Topoisomerase enzymes control the changes in DNA structure required for replication.

• Topoisomerase I inhibitors:    ironotecan, topotecan.
• Topoisomerase II inhibitors  : amsacrine, etoposide, etoposide phosphate, teniposide.

Note.    We strongly recommend that you talk to your healthcare provider about your specific medical condition and treatments. The information contained on this website is useful and educational in nature and does not replace medical advice.