(eye-rye-no-TEE-can)

Trade names: Camptosar^®

Other names: Camptothecin-11, CPT-11

Chemocare.com uses generic names in all descriptions of drugs. Camptosar is the trade name for irinotecan. Camptothecin-11 and CPT-11 are other names for irinotecan. In some cases, health care professionals may use the trade name camptosar or other names camptothecin-11 or CPT-11 when referring to the generic drug name irinotecan.

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

What Irinotecan Is Used For:

• Metastatic colon or rectal cancer

Note:  If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Irinotecan Is Given:

• This medication is given by infusion through a vein (intravenously, IV).
• There is no pill form of this medication.
• Irinotecan is an irritant.  An irritant is a chemical that can cause inflammation of the vein through which it is given.  If the medication escapes from the vein it can cause tissue damage.  The nurse or doctor who gives this medication must be carefully trained.  If you experience pain or notice redness or swelling at the IV site while you are receiving irinotecan, alert your health care professional immediately. 
• The amount of irinotecan that you will receive 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 the side effects listed.
• Side effects are often predictable in terms of their onset and duration.
• Side effects are almost always reversible and will go away after treatment is complete.
• There are many options to help minimize or prevent side effects.
• There is no relationship between the presence or severity of side effects and the effectiveness of the medication.
• The side effects of irinotecan and their severity depend on how much of the drug is given.  In other words, high doses may produce more severe side effects.

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

• Diarrhea; two types early and late forms.
• Early diarrhea: Occurring within 24 hours of receiving drug, accompanied by symptoms runny nose, increased salivation, watery eyes, sweating, flushing, abdominal cramping. (This can occur while the drug is being administered.  If so, alert your healthcare professional promptly.  Medication can be given to stop and/or lessen this early side effect).
• Late diarrhea: Occurring greater than 24 hours of receiving drug, usually peaks at about 11 days after treatment.  Because of concerns of dehydration and electrolyte imbalances with diarrhea it is important to be in contact with health care professionals for monitoring, and for medication and diet modifications advice. 
• Nausea and vomiting.
• Weakness.
• Low white blood cell count. (This can put you at increased risk for infection).
• Low red blood cell count (anemia).

Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts.

Onset: 10 days
Nadir: 14-16 days
Recovery: 21-28 days

• Hair loss
• Poor appetite
• Fever
• Weight loss

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

• Constipation
• Shortness of breath
• Insomnia (see sleep problems)
• Cough
• Headache
• Dehydration
• Chills (see flu-like symptoms)
• Skin rash (see skin reaction)
• Flatulence (see abdominal pain)
• Flushing of face during infusion
• Mouth sores
• Heartburn
• Swelling of feet and ankles

Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here.  However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should 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 an emergency.  Contact your health care provider within 24 hours of noticing any of the following:

• Diarrhea (4-6 episodes in a 24-hour period) despite use of anti-diarrhea medication and diet modifications.
• Nausea (interferes with ability to eat and unrelieved with prescribed medication).
• Vomiting (vomiting more than 4-5 times in a 24 hour period)
• Extreme fatigue (unable to carry on self-care activities)
• Mouth sores (painful redness, swelling or ulcers)

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

• Before starting irinotecan treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).   Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
• Do not receive any kind of immunization or vaccination without your doctor's approval while taking irinotecan.
• In general the use of laxatives or stool stimulants should be avoided because of the potential for worsening diarrhea.  Discuss any laxative use with your health care professional.
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (irinotecan) may be hazardous to the fetus.  Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
• For both men and women: Do not conceive a child (get pregnant) while taking irinotecan. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
• Do not breast feed while taking this medication.

Self-Care Tips:

• If you have redness or pain at the infusion site apply ice and notify your health care professional promptly.
• Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• Follow regimen of anti-diarrhea medication as prescribed by your health care professional. 
• Eat foods that may help reduce diarrhea (see managing side effects - diarrhea).
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. Sucking on lozenges and chewing gum may also help. 
• You may be at risk of infection so try to avoid crowds or people with colds or not feeling well, and report fever or any other signs of infection immediately to your health care provider.
• Wash your hands often.
• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day 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.  Wear SPF 15 (or higher) sunblock and protective clothing.
• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely.  You should discuss this with your doctor.
• Get plenty of rest. 
• Maintain good nutrition.
• If you experience symptoms or side effects, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

You will be checked regularly by your health care professional while you are taking irinotecan, to monitor side effects and check your response to therapy.  Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.   

How Irinotecan Works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue.   "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition.  Cancerous cells lose this ability.  Cancer cells no longer have the normal checks and balances in place that control and limit cell division.  The process of cell division, whether normal or cancerous cells, is through the cell cycle.  The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division.  Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division.  If the cells are unable to divide, they die.  The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink.  They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific.  Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific.  The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective.  This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing.  Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur.  The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss.  Different drugs may affect different parts of the body.

Irinotecan belongs to a class of chemotherapy drugs called plant alkaloids.  Plant alkaloids are made from plants.  The vinca alkaloids are made from the periwinkle plant (catharanthus rosea). The taxanes are made from the bark of the Pacific Yew tree (taxus).  The vinca alkaloids and taxanes are also known as antimicrotubule agents. The podophyllotoxins are derived from the May apple plant. Camptothecan analogs are derived from the Asian "Happy Tree" (Camptotheca acuminata).  Podophyllotoxins and camptothecan analogs are also known as topoisomerase inhibitors.  The plant alkaloids are cell-cycle specific.  This means they attack the cells during various 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 manipulation of the structure of DNA necessary for replication.

• Topoisomerase I inhibitors:  Ironotecan, topotecan.
• Topoisomerase II inhibitors:  Amsacrine, etoposide, etoposide phosphate, teniposide.

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org