Intravenously in the form of a 30-minute infusion.
Before the appointment of the first course of topotecan therapy, the amount of neutrophils should be ≥1500 / mkl, platelets -≥100000 / mkl, and the level of hemoglobin - ≥9 g / l.
Small cell lung cancer. Ovarian cancer.
At 1.5 mg / m2 daily for 5 consecutive days with an interval of 3 weeks. To achieve the effect, it is recommended to conduct a minimum of 4 courses of therapy (the average time of onset of the effect in patients with ovarian cancer is 8-11.7 weeks, in patients with small cell lung cancer - 6.1 weeks.) Approximately 18% of patients with ovarian cancer have an effect after 5 and more courses of therapy).
Repeated courses of topotecan therapy can be carried out only with the following indices: the number of neutrophils ≥1000 / μL, platelets - ≥100000 / mkl, and the level of hemoglobin - ≥9 g / l (including after a blood transfusion, if necessary). For severe neutropenia (neutrophil count less than 500 / μl) for 7 days or more, or febrile neutropenia, or in the event of delayed treatment due to neutropenia, it should be:
- reduce the dose of the drug to 1.25 mg / m2 per day or, if necessary, up to 1.0 mg / m2 per day, or
-following courses should be conducted with the appointment of preventive introduction of granulocyte colony-stimulating factor (G-CSF), starting from the 6th day of treatment (not earlier than 24 hours after the end of topotecan therapy). If neutropenia against the background G-CSF is preserved, the dose of topotecan should be reduced.If the number of platelets decreases with the previous course of chemotherapy less than 25,000 / μl, the dose of topotecan should be reduced in a similar way.
If, in connection with side effects, a dose reduction of the drug is required below 1.0 mg / m2, topotecan therapy should be discontinued.
Cervical cancer
The recommended dose of topotecan is 0.75 mg / m2 in the 1 st, 2 nd and 3 rd days. On the first day of therapy, before administration of topotecan, an infusion of cisplatin in a dose of 50 mg / m2. This scheme repeated every 21 days, only 6 courses. If signs of disease progression appear, topotskan should be discarded.
Repeated courses of topotecan therapy can be carried out only with the following indicators: the number of neutrophils ≥1500 / mkl, platelets - ≥100000 / mkl, and the level of hemoglobin - ≥9 g / l (including after a blood transfusion, if necessary). Febrile neutropenia (body temperature rise to 38 ° C and above mri neutrophil count less than 1,000 / L) for subsequent courses is recommended to reduce the dose of topotecan by 20% to 0.6 mg / m2.
If the number of platelets is less than 10,000 / μl, the dose of topotecan should be reduced in a similar way.
As an alternative to decreasing the dose of topotecan in febrileneutropenia, the introduction of G-CSF is recommended at the end of each subsequent course (before resorting to a reduction in the dose of topotecan). starting from the 4th day of treatment (not earlier than 24 hours after the end of topotecan therapy). If febrile neutropenia against the background of G-CSF persists, the dose of topotecan for subsequent courses should be reduced by 20% to 0.45 mg / m2.
Doses in patients with impaired renal function
Monoterapia
For patients with QC ≥40 ml / min correction of the dosing regimen is not required. The recommended dose for patients with SC from 20 to 39 ml / min is 0.75 mg / m2 in a day. Recommendations on the dosing regimen in patients with a decrease in CK less than 20 ml / min are absent.
Combination Therapy
Topotecan therapy in combination with cisplatin for the treatment of cervical cancer is recommended only for patients with a plasma creatinine concentration of less than 1.5 mg / dl. If during the treatment the concentration of creatine in the blood plasma exceeded 1.5 mg / dL. follow the recommendations of the instruction on the use of cisplatin to reduce its dose / withdrawal. In the case of cisplatin abolition, there is insufficient data on the continuation of topotecan therapy in the form of monotherapy in patients with cervical cancer.
Doses in patients with impaired liver function
For patients with impaired liver function (bilirubin concentration from 1.5 to 10 mg / dl) dose adjustment is not required.
Rules for the preparation of an infusion solution
The contents of the vial are dissolved in 4 ml of sterile water for injection to a concentration of 1 mg / ml. The resulting solution must be diluted with 0.9% sodium chloride solution or 5% dextrose solution to a concentration of 25-50 μg / ml. The prepared solution can be stored at a temperature of 5 ° to 30 ° C for a maximum of 24 hours.