Mike Birrer

The major side effects of topotecan are:

1. Myelosuppression
2. Diarrhea
3. Low blood counts
4. Susceptibility to infection

Topotecan hydrochloride (trade name Hycamtin) is a chemotherapy agent that is a topoisomerase I inhibitor.

 It is often used in the treatment of ovarian and lung cancers, as well as other cancer types.

Topotecan intercalates between DNA. This intercalation disrupts the DNA duplication machinery when it finds a site in the DNA where topotecan is intercalated. This disruption prevents DNA replication, and ultimately leads to cell death.

Common side effects include:

• nausea and vomiting
• loss of appetite
• change in taste
• thinned or brittle hair
• pain in the joints of the arms or legs lasting two to three days
• changes in the color of the nails 
• tingling in the hands or toes. 

More serious side effects such can include:

• unusual bruising or bleedingpain/redness/swelling at the injection site
• change in normal bowel habits for more than two days
• fever, chills, cough, sore throat
• difficulty swallowing
• dizziness
• shortness of breath
• severe exhaustion
• skin rash
• facial flushing
• female infertility by ovarian damage
• chest pain

Several of these side effects are associated with the excipient (the liquid used to carry the drug) used, Cremophor EL, a polyoxyethylated castor oil.

Allergies to drugs such as cyclosporine, teniposide and drugs containing polyoxyethylated castor oil may indicate increased risk of adverse reactions to paclitaxel. Dexamethasone is given prior to beginning paclitaxel treatment to mitigate some of the side effects. 

Leuprolide, a gonadotropin-releasing hormone analog may prevent ovarian damage, according to studies carried out in mice.

Fluorourasil is a drug which is used in the treatment of cancer. It is a irreversible inhibitor of thymidylate synthase. It belongs to the family of drugs called antimetabolites and is typically administered with leucovorin.

Side effects of fluorourasil include: 

• myelosuppression
• mucositis
• dermatitis
• diarrhea
• cardiac toxicity.

Cisplatin or cisplatinum (trade names Platinol) is a cytotoxic chemotherapy drug.

It is used to treat various types of cancers, including:

• sarcomas
• small cell lung cancer
• ovarian cancer
• lymphomas
• cervical cancer
• germ cell tumors.

Cisplatin was the first platinum-containing anti-cancer drugs, which now also includes carboplatin and oxaliplatin. These platinum complexes react in vivo, binding to and causing crosslinking of DNA, which ultimately triggers apoptosis (programmed cell death).

Side effects of Cisplatinum include:

• Nephrotoxicity (kidney damage)
• Neurotoxicity (nerve damage)
• Nausea and vomiting
• Ototoxicity (hearing loss)
• Electrolyte disturbance