Generic Name: Thiotepa (thye-oh-TEP-eh), TESPA, Thiophosphoamide, TSPA
Trade Name: Thioplex®,
How is this drug used? Thiotepa is FDA approved for the treatment of the following cancers: breast, ovary, bladder, lymphomas, Hodgkin’s disease, and lymphosarcoma. Thiotepa is also approved for intracavitary effusions caused by cancers It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Thiotepa belongs to a class of drugs called alkylating agents. Alkylating agents produce their anti-cancer effects by causing a chemical reaction that damages the DNA in a cell. The DNA damage caused by thiotepa results in cell death.
How is thiotepa given (administered)? Thiotepa may be administered into a vein (intravenous), into a body cavity (intracavitary), or into the bladder (intravesical) and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used and the overall health of the patient. Patients will be monitored for an allergic-type reaction that may occur, although uncommonly, when treated with thiotepa. Patients who experience difficulty breathing, closing of the throat, swelling of facial features, hives, chills or dizziness should tell their healthcare provider immediately.
How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with thiotepa. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. Patients will also be monitored for a condition called hemorrhagic cystitis (bleeding from the bladder), which is uncommon, with treatment of thiotepa administered into the bladder.
What are the common (occur in 30% or more of patients) side effects of treatment with thiotepa?
• Low white blood cell levels – increases risk of infection
• Low red blood cell levels – increases risk of anemia
• Low platelet levels – increases risk of bleeding
• Loss of hair
What are the less common (occur in 10% to 29% of patients) side effects of treatment with thiotepa?
• Nausea and vomiting
• Loss of appetite
• Bladder irritation if thiotepa is administered into the bladder
• Skin abnormalities – rash, redness, flaking, peeling, bronzing, hives
• Mouth sores
• Mild allergic-type reaction – rash, hives
This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.
Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.
What are the possible late side effects of treatment with thiotepa? Patients treated with thiotepa are at a slightly increased risk of developing a secondary malignancy. A secondary malignancy is a new and unrelated cancer that occurs in an individual as a result of previous treatment with radiation or chemotherapy. Patients should ask their physician about the possibility of developing a secondary malignancy as a result of their treatment.
What can patients do to help alleviate or prevent discomfort and side effects?
• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If possible, patients should avoid large crowds or persons who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• Eat small meals frequently to help alleviate nausea.
• For mouth sores, patients should rinse their mouth three times a day with a salt and soda solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.
Are there any special precautions patients should be aware of before starting treatment?
• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
When should patients notify their physician?
• Signs of an allergic-type reaction – difficulty breathing, closing of the throat, swelling of facial features, rash, hives, chills or dizziness
• Flu or cold-like symptoms – fever, chills, sore throat, cough
• Signs of infection – redness, swelling, pus, tenderness, painful urination
• Unexplained or excessive bleeding (nosebleeds, bruising, black tarry stools, blood in the urine, etc.)
• Persistent or severe fatigue
• Dizziness, headache
• Persistent or extreme nausea or vomiting
• Mouth sores
What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.
Important Limitations of Use
The information provided above on the drug you have selected is provided for your information only and is not a substitute for consultation with an appropriate medical doctor. We are providing this information solely as a courtesy and, as such, it is in no way a recommendation as to the safety, efficacy or appropriateness of any particular drug, regimen, dosing schedule for any particular cancer, condition or patient nor is it in any way to be considered medical advice. Patients should discuss the appropriateness of a particular drug or chemotherapy regimen with their physician.
As with any printed reference, the use of particular drugs, regimens and drug dosages may become out-of-date over time, since new information may have been published and become generally accepted after the latest update to this printed information. Please keep in mind that health care professionals are fully responsible for practicing within current standards, avoiding use of outdated regimens, employing good clinical judgment in selecting drugs and/or regimens, in calculating doses for individual patients, and verifying all dosage calculations.
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