How does it work?
Hycamtin infusion and capsules both contain the active ingredient topotecan, which is a chemotherapy medicine used to treat cancer.
Cancers form when some cells within the body multiply uncontrollably and abnormally. These cells spread, destroying nearby tissues. Topotecan works by stopping the cancer cells from multiplying.
Like normal healthy cells, cancer cells go through a continuous process of change. Each cell divides into two daughter cells. These cells grow, rest and then divide again. Chemotherapy medicines are powerful chemicals designed to interrupt this cycle and stop cells from growing and multiplying.
Before a cell divides to make two identical cells, it has to make a copy of its genetic material (DNA). An enzyme called topoisomerase I helps this process. Topotecan is a type of chemotherapy medicine known as a topoisomerase I inhibitor. It works by blocking the action of topoisomerase I. This prevents the cells from making copies of their DNA and so stops them dividing and increasing in numbers. This in turn stops the growth of abnormal tissue.
Unfortunately, topotecan can also affect normal, healthy cells, particularly those that multiply quickly, such as blood cells and hair cells. The most important side effect is on the bone marrow where blood cells are made. Topotecan can decrease the production of blood cells, leaving people susceptible to infection. Regular blood tests are therefore needed to monitor the levels of blood cells.
In most chemotherapy regimens, doses are administered in courses at various intervals to allow normal cells to recover from the adverse effects of the chemotherapy between doses. However, during this period, cancer cells will also recover and start to replicate again. Successful treatment depends on the administration of the next course of therapy before the cancer has regrown to its previous size. The aim is to decrease the amount of cancer with each successive course.
What is it used for?
- Cancer of the ovaries that has spread to other parts of the body, when treatment with other chemotherapy medicines has not been successful.
- Cervical cancer, in combination with cisplatin.
- Small cell lung cancer that has relapsed after initial treatment, when re-treatment with the first-line chemotherapy regimen is not considered appropriate.
How is this treatment given?
- Topotecan is usually given by a drip into a vein (intravenous infusion) over 30 mintues.
- Topotecan may also be given by mouth as capsules, but only to treat small cell lung cancer that has come back after previous chemotherapy.
- The length of your treatment and the number of cycles you have will depend on the type of cancer you are being treated for, how well it responds and how well your body copes with the chemotherapy.
- Hycamtin capsules should be swallowed whole with a glass of water. They can be taken either with or without food. The amount taken and how often will vary from person to person. It is important to follow the instructions given by your doctor and printed on the dispensing label. This medicine must only be taken under specialist medical supervision.
- Hycamtin capsules should not be chewed, crushed or broken. If you handle a capsule that is leaking or damaged, then you should immediately wash your hands with soap and water. If you get it in your eyes, wash them immediately with gently flowing water for at least 15 minutes and tell your doctor.
- Topotecan can sometimes cause diarrhoea, particularly if you are taking it by mouth, and this can be serious. If you experience more than three episodes of diarrhoea per day while having treatment with this medicine you should consult your doctor immediately. Make sure you drink plenty of fluids if you get diarrhoea.
- Topotecan can decrease the number of blood cells in your blood. A low white blood cell count can increase your susceptibility to infections; a low red blood cell count causes anaemia and a low platelet count can cause problems with blood clotting. For this reason, you will need to have regular blood tests to monitor your blood cells during treatment with this medicine. Tell your doctor immediately if you experience any of the following symptoms during your treatment, as they may indicate problems with your blood cells: unexplained bruising or bleeding, purple spots, sore mouth or throat, mouth ulcers, high temperature (fever) or other signs of infection, or suddenly feeling tired, breathless, or generally unwell.
- Topotecan may rarely cause lung inflammation (interstitial lung disease). If you get a new or worsening cough or shortness of breath, or a fever while having your treatment, you should tell your doctor straight away.
- As this medicine may be harmful to an unborn baby, women who could get pregnant should use effective contraception to prevent pregnancy both during treatment, and for at least a few months after treatment is finished. Men should use effective contraception to avoid fathering a child, both during treatment, and for at least a few months after treatment is finished.
- Your ability to become pregnant or father a child may be affected by taking this medicine. It is important to discuss fertility with your doctor before starting treatment.
Use with caution in
- Decreased kidney function.
- Decreased liver function.
- People with existing lung disease.
- People who have previously had radiotherapy treatment to their lungs, or treatments that have caused side effects on the lungs.
Not to be used in
- People with severely decreased production of blood cells by the bone marrow (myelosuppression), resulting in very low levels of white blood cells or platelets in the blood (for example due to radiotherapy or previous courses of chemotherapy).
- Severely decreased kidney function.
- Severely decreased liver function due to cirrhosis of the liver.
This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine should not be used during pregnancy, as it may be harmful to a developing baby. Women who could get pregnant should use effective contraception to prevent pregnancy, and men should use effective contraception to prevent fathering a child, both during treatment, and for at least a few months after treatment is finished. Seek medical advice from your doctor.
- It is not known if this medicine passes into breast milk. Mothers who need treatment with this medicine should not breastfeed. Seek medical advice from your doctor.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
Very common (affect more than 1 in 10 people)
- Decrease in the number of white blood cells, red blood cells or platelets in the blood (leukopenia, neutropenia, anaemia and thrombocytopenia) - see warning section above.
- Feeling or being sick. You will be given medicines to help prevent this.
- Diarrhoea - this may be severe. See warning section above.
- Inflammation and ulcers of the mouth, tongue or gums. This is lesss common if the medicine is taken by mouth.
- Hair loss.
- Loss of appetite.
- Feeling weak and tired.
- Disturbances of the gut such as constipation, indigestion or abdominal pain. This is less common if the medicine is taken by mouth.
Common (affect between 1 in 10 and 1 in 100 people)
- Rash or itching.
- Infection of the blood or body tissues with pus-forming or other pathogenic organisms (sepsis).
- Feeling generally unwell.
- Increased level of bilirubin in the blood (hyperbilirubinaemia). This may cause yellowing of the skin.
Rare (affect between 1 in 1000 and 1 in 10,000 people)
- Interstitial lung disease (see warning section above).
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines during treatment this one, to make sure that the combination is safe.
Vaccines may be less effective in people receiving chemotherapy. This is because chemotherapy medicines reduce the activity of the immune system and can prevent the body forming adequate antibodies. Live vaccines should be postponed until at least six months after finishing chemotherapy because they may cause infection. Live vaccines include the following: oral polio; rubella; measles, mumps and rubella (MMR); BCG; chickenpox; yellow fever and oral typhoid vaccines.
There may be an increased risk of side effects if this medicine is used in combination with other medicines that can affect blood cell counts, for example other chemotherapy medicines, or the antipsychotic clozapine.
Ciclosporin may increase the blood level of topotecan taken by mouth and could increase the risk of its side effects.
Other medicines containing the same active ingredient
Topotecan infusion is also available without a brand name, ie as the generic medicine.