Common chemotherapeutic agents for small-cell lung cancer (SCLC) include etoposide, irinotecan, and topotecan, which are usually combined with cisplatin or carboplatin in a platinum-containing two-drug regimen, or used alone.
For specific dosing regimens, which we cover in a separate article, we have a list of commonly used chemotherapy agents for SCLC, describing their respective uses, common adverse effects, and precautions to take during treatment.
Etoposide
Etoposide is a class of topoisomerase II inhibitors that slow or stop the growth of cancer cells.
- Use: Intravenous injection. The dose depends on your condition and how well you respond to treatment.
- Common adverse reactions: nausea, vomiting, loss of appetite, diarrhea, mouth pain, hair loss, etc. Nausea and vomiting may be severe and the doctor may prescribe medication to prevent or relieve them if necessary.
- Precautions before use.
- Before using the medication, inform your doctor of your drug allergy history and current medication use (including prescription, over-the-counter, and herbal medications).
- Before medication, inform your doctor of your medical history, especially kidney disease, liver disease, hematologic disorders (low red blood cell/white blood cell, platelet levels), having received radiation therapy, chemotherapy.
- Etoposide makes people more susceptible to, or aggravates, existing infections. Wash your hands thoroughly to prevent the spread of infection, do not contact people with influenza or chickenpox, and tell your doctor if you have been infected.
- Check with your doctor first if you are getting vaccinated, and do not contact people who have recently had a live vaccine (such as the inhaled flu vaccine).
- Be careful when using sharp objects such as razors or nail clippers and do not participate in physical activities that involve physical contact to reduce the possibility of cuts, bruises, or injuries.
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Caution
- Inform your doctor or dentist before surgery of all medications you are taking, including prescription, over-the-counter, and herbal medications.
- While on medication, do not eat grapefruit, sour orange, grapefruit, or drink these juices; the ingredients in these fruits can interfere with the metabolism of etoposide and diminish the effects of the medication.
- During medication, drink less alcoholic beverages if daily alcohol intake increases the risk of gastric bleeding.
- The elderly may be more sensitive to adverse reactions, especially sleepiness, weakness, sore mouth or throat, loss of appetite, decreased white blood cells, and dehydration, and should use the medication with extra caution.
- Etoposide may be harmful to the fetus, so tell your doctor if you are pregnant or planning to become pregnant, and be careful with contraception for women during use and for 6 months after you stop taking the drug.
- Men should use contraception while taking the drug and for 4 months after stopping, and tell your doctor if you or your partner is pregnant.
- Etoposide passes into breast milk and may be harmful to the baby; breast-feeding is not recommended while taking this medicine.
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Iritecan (Irinotecan)
Irinotecan is a class of topoisomerase I inhibitors that stop the growth of cancer cells.
- Use: Intravenous injection. The exact dose depends on your condition, response to treatment, and body type.
- Common adverse reactions: nausea, vomiting, diarrhea, loss of appetite, constipation, cough, sleepiness, mouth pain, weakness, poor sleep, and hair loss. Nausea and vomiting may be severe, and your doctor may prescribe medication to prevent or relieve them if necessary.
- Precautions before use.
- Before using the medication, inform your doctor of your drug allergy history and current medication use (including prescription, over-the-counter, and herbal medications).
- Before taking the medication, inform your doctor of your medical history, especially of intestinal obstruction, inherited metabolic disorders (such as fructose intolerance), blood or bone marrow abnormalities (such as low levels of red blood cells, white blood cells, platelets), diabetes, liver disease, kidney disease, lung disease, and having received radiation therapy.
- Before surgery, tell your doctor or dentist that you are using irinotecan.
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Cautions
- Iritecan may make you dizzy or affect your vision, and ingestion of alcohol may worsen it. Be careful driving, operating machinery, or doing any work that requires you to stay highly stressed while taking the drug.
- Drinking alcoholic beverages sparingly and getting up slowly while sitting or lying down may prevent dizziness or a feeling of lightheadedness.
- Check with your doctor first if you are going to get vaccinated, and do not contact people who have recently used the oral polio vaccine or the inhaled flu vaccine.
- Be careful when using sharp objects such as razors or nail clippers, do not participate in physical activities with physical contact to reduce the possibility of cuts, bruises, or injuries, and please wash your hands thoroughly to prevent the spread of infection.
- The elderly are more sensitive to adverse reactions, especially diarrhea, and should be extra careful with medications.
- Iritecan may be harmful to the fetus. Use contraception while taking the medicine and tell your doctor if you are pregnant or think you may be pregnant.
- It is not known if irinotecan passes into breast milk; it may be harmful to the baby and breast-feeding is not recommended while taking the medicine.
Topotecan (Topotecan)
Topotecan is a class of topoisomerase I inhibitors that kill cancer cells.
- Use: Intravenous injection. The exact dose depends on your disease, response to treatment, lab test results, and body type.
- Common adverse reactions: nausea, vomiting, diarrhea, constipation, abdominal pain, weakness, fatigue, or oral pain.
- Precautions before use.
- Before using the medication, inform your doctor of your drug allergy history and current medication use (including prescription, over-the-counter, and herbal medications).
- Before using the medication, inform your doctor of your medical history, especially liver disease and kidney disease.
- Topotecan makes you feel unusually tired, and ingesting alcohol can worsen your symptoms. Be careful driving, operating machinery, or doing any work that requires you to stay highly stressed while taking the drug, and drink less alcoholic beverages.
Cautions
- Topotecan may make people more susceptible to infection or worsen an existing infection. Do not contact people with influenza or chickenpox, and be careful when using sharp objects such as razors or nail clippers.
- Do not participate in physical activities that involve physical contact to reduce the possibility of cuts, bruises, or injuries, and tell your doctor if you are already infected.
- Consult your doctor first if you are going to get vaccinated; do not come into contact with people who have recently used live vaccines (such as the inhaled flu vaccine).
- Topotecan may be harmful to the fetus; women should use contraception during treatment and for 1 month after stopping the drug; men should use contraception during treatment and for 3 months after stopping the drug; tell your doctor if you or your partner is pregnant.
- It is not known if topotecan passes into breast milk; it may be harmful to the baby and breast-feeding is not recommended while taking the drug.
Cisplatin (Cisplatin)
Cisplatin is a platinum-containing compound that stops or slows the growth of cancer cells.
- Use: Intravenous, usually every 3-4 weeks, depending on your disease, response to treatment, and body type.
- Common adverse reactions: nausea, vomiting, loss of appetite, diarrhea, hair loss, nephrotoxicity, ototoxicity, loss of taste, etc. Nausea and vomiting may be severe and persistent, and your doctor prescribes medication to prevent or relieve it.
- Precautions before use.
- Before using the medication, inform your doctor of your drug allergy history and current medication use (including prescription, over-the-counter, and herbal medications).
- Before medication, inform your doctor of your medical history, especially kidney disease, bone marrow suppression, blood cell abnormalities (e.g., anemia, leukopenia, thrombocytopenia), hearing impairment, mineral imbalance in the body (low blood sodium, potassium, magnesium, calcium, phosphate levels, etc.), numbness in the hands and feet, kidney stones, and gout.
Cautions
- Consult your doctor first if you are going to get vaccinated and do not contact people who have recently used live vaccines (such as oral polio vaccine).
- Be careful when using sharp objects such as razors or nail clippers, do not participate in physical activities that involve physical contact to reduce the possibility of cuts, bruises, or injuries, and wash your hands thoroughly to prevent the spread of infection.
- The elderly are more sensitive to adverse reactions, especially kidney disease, numbness in the hands and feet, infections, and bleeding, so take extra care with medications.
- Cisplatin may be harmful to the fetus, and women of childbearing age should take care of contraception during the drug and for a period of time after stopping it. Cisplatin can also affect sperm production in men, and men should also take care of contraception during treatment and for a period of time after stopping it.
- Cisplatin passes into breast milk, it may be harmful to the baby, and breastfeeding is not recommended during drug use.
Carboplatin (Carboplatin)
Carboplatin is a second-generation platinum-containing compound that stops or slows the growth of cancer cells, and it is less toxic than cisplatin.
- Use: Intravenous, usually no more than once every 4 weeks, depending on your disease, response to treatment, and body type.
- Common adverse reactions: abdominal pain, body aches, diarrhea, constipation, weakness, nausea, vomiting, bone marrow suppression, hair loss, etc. Some patients have more severe nausea and vomiting reactions, but they usually go away within 24 hours of treatment, and your doctor will prescribe medications to prevent or relieve them.
- Precautions before use.
- Before using the medication, inform your doctor of your drug allergy history and current medication use (including prescription, over-the-counter, and herbal medications).
- There are some conditions in which carboplatin should not be used. Before dosing, inform your doctor if you have bone marrow suppression, blood cell abnormalities (e.g., anemia, leukopenia, thrombocytopenia).
- Before using the drug, inform your doctor of your medical history, especially kidney disease, mineral imbalances in your body (low blood sodium, potassium, magnesium, calcium levels, etc.).
Cautions
- Consult your doctor first if you are going to get vaccinated and do not contact people who have recently used live vaccines (such as oral polio vaccine).
- Be careful when using sharp objects such as razors or nail clippers, do not participate in physical activities that involve physical contact to reduce the possibility of cuts, bruises, or injuries, and wash your hands thoroughly to prevent the spread of infection.
- The elderly are more sensitive to adverse reactions, especially bleeding and numbness in the hands and feet, and should be extra careful with medications.
- Carboplatin is harmful to the fetus. Women of childbearing age should take care of contraception during the drug and for a period of time after stopping it.
- It is not known if carboplatin passes into breast milk; it may be harmful to the baby, and breastfeeding is not recommended during drug administration.
Co-reviewed by Dr. Sun Yueli and Dr. Li Wenfeng of Guangdong Provincial People’s Hospital and Guangdong Lung Cancer Institute.