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    Irinotecan (Campto)
    Irinotecan is a chemotherapy drug used to treat many different types of cancer.
    Irinotecan works by blocking an enzyme, called topoisomerase I. Cells need this enzyme to divide and grow. Irinotecan blocks this enzyme so the cancer cells can't divide.

    Fast facts about colon or rectal cancer:
    • It is the third most common cancer in men and women
    • Approximately 1 in 20 Americans will be diagnosed with colon or rectal cancer in his or her lifetime
    • In 2014, the number of people diagnosed with colon or rectal cancer in the United States was about:
      • 71,830 men
      • 65,000 women
    What is refractory metastatic colon or rectal cancer?
    means that the cancer may continue to grow despite treatment. The cancer may be resistant at the beginning of treatment or it may become resistant during treatment.
    Metastatic means that the cancer has spread to other parts of the body.
    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.

    You have irinotecan as cycles of treatment. Your treatment plan depends on whether you’re having irinotecan on its own or with other chemotherapy drugs.
    You have irinotecan as a drip into your bloodstream (intravenously). Each treatment takes between 30 and 90 minutes.
    You can have it through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.
    You can also have it through a long line - a central line, a PICC line or a portacath.
    These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.

    You might have irinotecan every 2 or 3 weeks. Each 2 or 3 week period is a cycle of treatment.
    You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
    Side effects of irinotecan (Campto)
    Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them.

    Increased risk of getting an infection
    Breathlessness and looking pale
    Bruising, bleeding gums or nosebleeds
    Tiredness and weakness (fatigue) during and after treatment
    Loss of appetite
    Feeling sick or being sick
    Hair loss
    Mouth sores and ulcers
    Tummy (abdominal) pain
    Occasional side effects
    Between 1 and 10 in every 100 people have one or more of these effects.

    Liver changes
    High blood pressure
    Swelling around the drip site
    Skin rash
    Blood Clots
    You could also have:
    • muscle cramps and twitches
    • pins and needles
    • temporary speech problems
    • temporary eyesight changes
    Pregnancy and contraception
    Irinotecan may have a harmful effect on a developing baby so you should not become pregnant or father a child whilst taking this drug. Talk to your doctor or nurse about contraception before beginning treatment if there is any possibility that you or your partner could become pregnant. Women need to continue with reliable contraception for a month after treatment ends and men need to continue for 3 months.
    You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.
    Don’t breastfeed during this treatment because the drug may come through into your breast milk.
    Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
    In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and shingles vaccine (Zostavax).
    You can:

    • have other vaccines, but they might not give you as much protection as usual
    • have the flu vaccine (as an injection)
    • be in contact with other people who've had live vaccines as injections
    Avoid close contact with people who’ve recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.
    This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So, avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.
    You should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened.

    Part 2 is in the next post
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