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Treatment Name: Topotecan (Hycamtin®)

Topotecan (Hycamtin®) is a Chemotherapy Regimen for Lung Cancer, Small Cell Lung Cancer (SCLC)

How does topotecan work?
Topotecan is designed to slow the growth and kill cancer cells by stopping the production of DNA in small cell lung cancer cells.

Goals of therapy:
Topotecan is not commonly given with the goal of cure, but rather to shrink tumors. This may lead to a decrease in symptoms caused by small cell lung cancer, such as fatigue, shortness of breath, coughing with or without blood, hoarseness, decreased appetite, chest pain, or trouble sleeping.

Schedule

  • If oral therapy: Topotecan (usually between 3 - 6 capsules) by mouth Once Daily on Days 1,2,3,4, and 5
    OR
  • If intravenous therapy: Topotecan intravenous (I.V.) infusion over 30 minutes on Days 1,2,3,4, and 5

If receiving I.V., estimated total infusion time for this treatment:

  • Up to 2 hours for each cycle
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time

Oral Topotecan capsules are usually taken at home by mouth. Several capsules will need to be taken together to equal the total dose prescribed by the Doctor. The number of capsules will vary depending on the dose and strength of the capsules prescribed. Oral topotecan is taken for the first 5 consecutive days only of each 21-day cycle.

If topotecan is given I.V., it is usually given in an outpatient infusion center, allowing the person to go home afterwards. Topotecan infusion is given for 5 consecutive days every 21 days. This is known as one Cycle.

Each cycle may be repeated until topotecan no longer works or until unacceptable side effects are seen.

Click here for common Topotecan starting doses

Side Effects

In clinical studies, the most commonly reported topotecan (Hycamtin®) side effects are shown here. Side effects sometimes have percentage ranges [example 61 – 88%] because they differed between in clinical studies:

Approximately 12% of patients discontinue both oral and I.V. topotecan due to unacceptable side effects.

Diarrhea may be more common in patients taking oral topotecan compared to I.V. topotecan

Hair loss from topotecan is usually mild, not obvious from a distance, and seen only on close inspection; Although a different hair style can help cover any hair loss, a wig or hair piece is usually not required.

The exact incidence of vomiting is unknown as newer, more effective medications to prevent and treat nausea were made available after the clinical studies referenced were published

Side effect videos Side Effect Videos
Hair LossHair LossAnemiaAnemiaFatigue Fatigue Nausea and VomitingNausea and VomitingNeutropenic FeverNeutropenic FeverDiarrheaDiarrheaConstipationConstipationPainPainBlood ClotsBlood Clots

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before each cycle of chemotherapy and weekly or every other week during treatment until stable. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment then periodically during treatment, such as at the end of each cycle or every other cycle. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, positron emission tomography (PET) scans, or ultrasound.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue topotecan 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

  • If taking topotecan by mouth, you may receive two different strengths of topotecan (0.25 mg and 1 mg) from the pharmacy to combine together to equal your total prescribed dose. The topotecan 0.25 mg capsules and the topotecan 1 mg capsules may be different colors, such as white and pink. To avoid taking too little or too much, be sure to ALWAYS check that you are taking the right amount of each capsule strength with each daily dose
  • Diarrhea with topotecan can be common and typically happens around day 9 of each cycle. Talk to your doctor or pharmacist about ways you can treat mild diarrhea. If you are experiencing more than 4 loose stools per day, call your doctor immediately
  • 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 Topotecan (Hycamtin®), 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 Topotecan (Hycamtin®). Depending upon your income, they may be able to help cover the cost of:

  • Topotecan ORAL

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 Topotecan (Hycamtin®) 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 Topotecan (Hycamtin®)

Individual Drug Label Information

Topotecan ORAL (Hycamtin®)

  • Topotecan is available as an intravenous infusion or an oral capsule with two strengths: 0.25 mg and 1 mg capsules 
  • An oral dose may combine both capsules strengths and multiple capsules of each
  • Swallow capsules whole with water with or without food
  • Topotecan capsules should be stored in the refrigerator (36 to 46 degress fahrenheit, 2 to 8 degrees celsius)
  • Dosage adjustments may be required for kidney function and low blood counts
  • If you miss an oral dose, take the dose as soon as you remember if it’s the same day. If it is the next day, take your regular dose as scheduled. Do not double your dose to make up for the missed dose
  • If you vomit up an oral dose, do not take another dose on the same day and wait until the next scheduled dose is due
  • May cause fetal harm, avoid this drug during pregnancy. Use effective contraception during treatment and for 3 months after discontinuing treatment
General Topotecan (Hycamtin) Side Effects
  • Commonly causes red blood cells, white blood cells, and platelets to decrease
  • Diarrhea can be common. Talk to your doctor or pharmacist about ways you can treat mild diarrhea and call your doctor if you are experiencing severe diarrhea
  • Nausea risk is low. Talk to your doctor if you are experiencing nausea after taking topotecan
  • Fatigue
  • Hair loss
  • Weight loss
  • Abdominal pain
  • Liver injury
  • Fever
  • Infection
  • Shortness of breath
  • Weakness
  • Click on the topotecan (Hycamtin) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossFatigue Fatigue AnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

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References

1) Von Pawel J, Schiller JH, Shepherd FA, et al. Topotecan versus cyclophosphamide, doxorubicin, and vincristine for the treatment of recurrent small-cell lung cancer. J Clin Oncol. 1999;17:658-667.

2) O’Brien M, Ciuleanu TE, Tsekov H, et al. Phase III trial comparing supportive care alone with supportive care with oral topotecan in patients with relapsed small-cell lung cancer. J Clin Oncol. 2006;24:5441-5447.

3) Eckardt JR, von Pawel J, Pujol JL, et al. Phase III study of oral compared with intravenous topotecan as second-line therapy in small-cell lung cancer. J Clin Oncol. 2007;25:2086-2092.

4) Ardizzoni A. Topotecan in the treatment of recurrent small cell lung cancer: an update. Oncologist. 2004;9 Suppl 6:4-13.

Created: August 28, 2016 Updated: August 28, 2016

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, doctors use 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.

Common Topotecan starting doses

  • If taking BY MOUTH: Topotecan 2.3 mg/m2/day (using a combination of 0.25mg and 1 mg capsules) by mouth Once Daily on Days 1, 2, 3, 4, and 5
  • If receiving BY VEIN: Topotecan 1.5 mg/m2/day intravenous (I.V.) infusion over 30 minutes on Days 1, 2, 3, 4, and 5

NOTE: it is recommended to round each dose to the nearest 0.25 mg, and prescribe the minimum quantity of 1-mg and 0.25-mg capsules for each cycle.

Also, for oral topotecan, do NOT alternate the number of capsules to be taken for any of the 5 dosing days. To minimize mistakes, the same number of capsules should be given for Days 1, 2, 3, 4, 5 (should be same total dose each day).

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

Clinical Studies

If you are interested in reading the clinical trials results, please click on references below:

1) Von Pawel J, Schiller JH, Shepherd FA, et al. Topotecan versus cyclophosphamide, doxorubicin, and vincristine for the treatment of recurrent small-cell lung cancer. J Clin Oncol. 1999;17:658-667.

2) O’Brien M, Ciuleanu TE, Tsekov H, et al. Phase III trial comparing supportive care alone with supportive care with oral topotecan in patients with relapsed small-cell lung cancer. J Clin Oncol. 2006;24:5441-5447.

3) Eckardt JR, von Pawel J, Pujol JL, et al. Phase III study of oral compared with intravenous topotecan as second-line therapy in small-cell lung cancer. J Clin Oncol. 2007;25:2086-2092.

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

What is k/μL?

It is an abbreviation for thousand per microLiter, which is a measurement of quantity per volume unit of blood.