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Treatment Name: Cisplatin (Platinol®) + Irinotecan (Camptosar®)

Cisplatin (Platinol®) + Irinotecan (Camptosar®) is a Chemotherapy Regimen for Lung Cancer, Small Cell Lung Cancer (SCLC)

How does cisplatin + irinotecan work?
Each of the medications in cisplatin + irinotecan are designed to kill or slow the growth of lung cancer cells.

Goals of therapy:
Cisplatin + irinotecan is given to shrink tumors and decrease symptoms of extensive stage lung cancer. It is not commonly given with the goal of cure, but may help patients live longer.

Schedule

Every 28-day regimen

  • Cisplatin intravenous (I.V.) infusion over one hour on Day 1
  • Irinotecan I.V. infusion over 90 minutes on Days 1, 8, and 15

Every 21-day regimen

  • Cisplatin I.V. infusion over one hour on Days 1 and 8
  • Irinotecan I.V. infusion over 90 minutes on Days 1 and 8 


Estimated total infusion time for this treatment:

  • Every 28-day regimen: Up to three hours for Day 1 of each treatment cycle. Up to two hours for Days 8 and 15 of each treatment cycle
  • Every 28-day regimen: Up to three hours for Days 1 and 8 of each treatment cycle
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and I.V. fluids, such as hydration, may add more time 

Cisplatin + irinotecan is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, it may be given in the hospital if someone is too sick.

Cisplatin + irinotecan is repeated every 21 or 28 days. This is known as one Cycle. Each cycle may be repeated up to four times, depending upon the stage of the disease. In some cases, more than four cycles may be given as decided by your doctor. Therapy may last up to four months or sometimes longer, depending upon response, tolerability, and number of cycles prescribed.

Click here for the  common cisplatin + irinotecan starting doses.

Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect.  In clinical studies, the most commonly reported side effects of cisplatin + irinotecan are shown here. Side effects sometimes have percentage ranges [example: 36 – 65%] because they differed between clinical studies:

 On average, 15% of patients discontinue treatment due to unacceptable side effects.

Side effect videos Side Effect Videos
DiarrheaDiarrheaNausea and VomitingNausea and VomitingFatigue Fatigue Hair LossHair LossAnemiaAnemiaNeutropenic FeverNeutropenic FeverPainPain

Monitoring

How often is monitoring needed?
Labs (blood tests) are usually checked before treatment on Day 1 of each cycle. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), blood magnesium level, plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment then approximately after every two cycles of treatment. Imaging may include: X-rays, magnetic resonance imaging (MRI) or computerized tomography (CT) scans.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue cisplatin + irinotecan as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.

ChemoExperts Tips

  • Diarrhea caused by irinotecan is commonly treated with atropine injections in the medical setting, both before and/or after the irinotecan infusion. Diarrhea at home is commonly treated with loperamide purchased over-the-counter at a pharmacy. You may receive special instructions on how to use loperamide for diarrhea caused specifically by irinotecan. Severe diarrhea at home should be reported to the cancer doctor immediately or patients should go to an emergency department immediately
  • Intravenous (I.V.) fluids may be given while receiving cisplatin to maintain good hydration and protect against kidney damage. These fluids may contain electrolytes such as potassium and magnesium
  • Cisplatin can cause severe nausea and delayed nausea, but is usually well managed with appropriate anti-nausea medicines. Make sure your doctor prescribes anti-nausea medicines for you to have at home if necessary
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for small cell lung cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Cisplatin (Platinol®) + Irinotecan (Camptosar®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Cisplatin (Platinol®) + Irinotecan (Camptosar®). Depending upon your income, they may be able to help cover the cost of:

  • Cisplatin
  • Irino­tecan

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Cisplatin (Platinol®) + Irinotecan (Camptosar®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Cisplatin (Platinol®) + Irinotecan (Camptosar®)

Individual Drug Label Information

Cisplatin (Platinol®)

  • Cisplatin is an intravenous (I.V.) infusion that is typically given over one to two hours
  • Cumulative toxicity to kidneys from cisplatin can be severe 
  • Other toxicities from multiple doses are:  low blood counts, nausea, vomiting, and hearing loss
  • Dosage adjustments may be required for poor kidney function or bone marrow toxicity (low blood counts) 
  • Cisplatin is hazardous to a human fetus; women should avoid pregnancy while on this drug 
  • Women should not breast-feed while on cisplatin; it has been reported to be in human milk 
  • Patients on anticonvulsant drugs may have decreased levels while on cisplatin 
General Cisplatin (Platinol) Side Effects 
  • Kidney problems (nephrotoxicity), especially in elderly patients. 
  • Nausea and vomiting, both acute (within first 24 hours) and delayed (two to five days after infusion) 
  • Diarrhea 
  • Low blood cell counts (myelotoxicity, acute leukemia)
  • Hearing problems- ringing ears.  All patients should have a baseline hearing test done.  All children should have hearing test done before each dose and for several years after therapy is complete 
  • Low blood electrolytes:  magnesium, potassium, calcium, sodium, and phosphate
  • Nerve pain 
  • Vision problems; improvement and/or complete recovery usually occurs after stopping therapy 
  • Liver toxicity; recovery usually occurs after stopping therapy 
  • Click on the cisplatin (Platinol) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue PainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Irino­tecan (Camp­tosar®)

  • Irinotecan is an intravenous (I.V.) drug
  • Recommended to be given only under the supervision of a qualified physician well versed in administering chemotherapy
  • Can induce two forms of diarrhea: early and late. Late usually occurs 24 hours after finishing an irinotecan infusion.  Late diarrhea can be life threatening and should be quickly reported to your physician or visit an emergency department immediately
  • Severe low white blood count may occur, which can lead to infections
  • Dosage adjustments may be required for patients experiencing severe diarrhea, liver dysfunction, or patients with very low white blood cell counts (neutropenia)
  • Irinotecan can interact with ketoconazole and St. John’s Wort.  Those medications should be stopped 2 weeks before starting irinotecan therapy
  • There are known drug interactions of irinotecan with CYP3A4 inducers:  phenytoin, phenobarbital, carbamazepine, rifampin, rifabutin, and atazanavir
General Irinotecan (Camptosar) Side Effects
  • Diarrhea
  • Nausea
  • Vomiting
  • Low white blood cell count (neutropenia)
  • Fevers from low white blood cell count (neutropenic fever)
  • Mouth sores and inflammation (mucositis)
  • Inflammation of the large intestine (colitis)
  • Kidney impairment or kidney failure has rare reports
  • Blockage of blood vessels by a clot (thromboembolism)
  • Lung toxicities, such as shortness of breath or cough
  • Avoid during pregnancy, known to cause fetal harm
  • Click on the irinotecan (Camptosar) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossFatigue Fatigue PainPainNeutropenic FeverNeutropenic FeverBlood ClotsBlood Clots

See DailyMed package insert.

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References

1. Noda K, Nishiwaki Y, Kawahara M, et al. Irinotecan plus cisplatin compared with etoposide plus cisplatin for extensive small-cell lung cancer. N Engl J Med 2002;346(2):85-91.

2. Hanna N, Bunn PA Jr, Langer C, et al. Randomized phase III trial comparing irinotecan/cisplatin with etoposide/cisplatin in patients with previously untreated extensive-stage disease small-cell lung cancer. J Clin Oncol 2006;24(13):2038-43.

Created: July 12, 2017 Updated: July 12, 2017

What is Lung Cancer, Small Cell Lung Cancer (SCLC)?

What is Small Cell Lung Cancer?
A disease of the tissue found in the lung. Small cell lung cancer (SCLC) is the second most common type of lung cancer, occuring in 10% to 15% of cases. It occurs most commonly in smokers and because it spreads rapidly, up to 70% of patients have metastatic disease at diagnosis. SCLC responds very well to chemotherapy and radiation because of its rapid-type growth.

The stage of SCLC can vary at diagnosis and throughout treatment. Most doctors classify patients two ways: Limited stage or Extensive stage.

  • Limited stage SCLC generally means it is found only in one lung, in lymph nodes on one side of the chest, and can be treated with radiation in a single field, chemotherapy, or a combination of these. About one-third of patients with small cell lung cancer are diagnosed with limited stage.
  • Extensive stage is when tumors are found in both lungs and distant organs. This is usually treated with only chemotherapy (and NO radiation) because the cancer is widespread and whole body radiation would be too toxic. Two-thrids of patients with small cell lung cancer are diagnosed with extensive stage

Doctors may also use the Tumor, Node, Metastasis (TNM) staging. Once TNM categories have been decided by the doctor, stage grouping is used: Stages are: 0, 1, 2, 3, or 4  (0, I, II, III, IV), with some sub-grouping using letters A and B. The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What does Cure mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

What is Extensive Stage?

Extensive stage is when tumors are found in both lungs and distant organs. This is usually treated with only chemotherapy (and NO radiation) because the cancer is widespread and whole body radiation would be too toxic. Two-thirds of patients with small cell lung cancer are diagnosed with extensive stage.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium

Common Starting Doses

Every 28-day regimen: 

  • Cisplatin 60 mg/m2 intravenous (I.V.) infusion over one hour on Day 1
  • Irinotecan 60 mg/m2 I.V. infusion over 90 minutes on Days 1, 8, and 15 

Every 21-day regimen: 

  • Cisplatin 30 mg/m2 I.V. infusion over one hour on Days 1 and 8
  • Irinotecan 65 mg/m2 I.V. infusion over 90 minutes on Days 1 and 8

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability.