- 1st line treatment metastatic colorectal cancer:
- Combination therapy:
- Regimen 1: 180mg/m² IV infusion over 30-90 min *1 on days 1, 15 and 29 of 42-day cycle then infusion with leucovorin and 5-fluorouracil
- Regimen 1: 180mg/m² IV infusion over 30-90 min *1 on days 1, 15 and 29 of 42-day cycle then infusion with leucovorin and 5-fluorouracil
- Combination therapy:
-
-
- Regimen 2: 125mg/m² IV infusion over 90 min on days 1, 8, 15 and 22 of 42-day cycle, then bolus doses of leucovorin and 5-fluorouracil
-
-
- Monotherapy:
- Regimen 1: 125mg/m² IV infusion over 90 minutes on days 1, 8, 15 and 22, then 2 weeks off, then repeat
- Monotherapy:
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-
- Regimen 2: 350mg/m2 IV infusion over 30-90 minutes every weeks
-
Injection: 20mg/mL
- Patient should be pre-medicated with anti-emetics at least 30 min prior to infusion
- Atropine considered in patients with cholinergic symptoms
- For combination therapy, administer irinotecan, leucovorin then fluorouracil
Topoisomerase I inhibitor anticancer
It binds to topoisomerase I-DNA complexes, preventing religation of single-strand breaks
- Anemia
- Neutropenia
- Leukopenia
- Thrombocytopenia
- Elevated bilirubin
- Diarrhea
- Nausea
- Vomiting
- Asthenia
- Abdominal pain
- Alopecia
- Anorexia
- Fever
- Weight loss
- Constipation
- Mucositis
- Stomatitis
- Pain
- Dyspnea
- Dizziness
- Cough
- Insomnia
- Headache
- URI
- Diaphoresis
- Dehydration
- Rash
- Infection
- Elevated LFTs
- Edema
- Abdominal distension
- Somnolence
- Vasodilation
- Hypotension
- Thromboembolism
- Pneumonia
- Confusion
- Pregnancy 1st trimester
- Bilirubin >2
- GI obstruction
- Severe myelosuppression
- Avoid breastfeeding during treatment and for at least 7 days after discontinuing
- Hypersensitivity to components/class
WARNING:
- Diarrhea:
- Both early and late forms of diarrhea can occur
- Early diarrhea during or shortly after infusion may occur with cholinergic symptoms and abdominal cramping which may be prevented or ameliorated by atropine
- Late diarrhea usually >24 hours after infusion can be life threatening and should be treated promptly with loperamide
- Monitor and give fluid and electrolytes as needed
- Institute antibiotic therapy if patients develop ileus, fever or severe neutropenia
- Interrupt irinotecan and reduce subsequent doses if severe diarrhea occurs
- Myelosuppression:
- Severe myelosuppression may occur
- Deaths reported due to sepsis following severe neutropenia
- Temporarily omit irinotecan during cycle if febrile neutropenia or ANC <1000/mm3, resume reduced dose once ANC >1000/mm3
- Carbamazepine
- Clozapine
- Cobicistat
- Conivaptan
- Darunavir
- Fosamprenavir
- Indinavir
- Itraconazole
- Lopinavir
- Rifampin
- Ritonavir
- Live vaccines
- Atazanavir
- Ketoconazole
Drug Status
Availability | Prescription only |
Pregnancy | Category D |
Breastfeeding | Contraindicated |
Schedule | Not controlled |
BRAND NAME | STRENGTH | FORMULATION | PACK SIZE | MANUFACTURER | DISTRIBUTOR |
---|---|---|---|---|---|
Campto | 20mg/mL | Injection | 1’s | Pfizer Labs | Pfizer Labs |
Glirin | 40mg/2mL | Injection | 1’s | Glenmark Pharma | Glenmark Pharma |
Glirin | 100mg/5mL | Injection | 1’s | Glenmark Pharma | Glenmark Pharma |
Irinotel | 20mg/mL | Injection | 1’s | Fresenius Kabi | Nairobi Enterprises |
Irinotel | 100mg/5mL | Injection | 1’s | Fresenius Kabi | Nairobi Enterprises |