Tepadina

Indications

Thiotepa is an anticancer medicine used mainly as part of conditioning treatment before a blood stem cell (bone marrow) transplant in adults and children with certain blood cancers, blood disorders and some solid tumours. It may also be used for some other cancers, such as certain breast, ovarian or bladder cancers, and to control fluid build-up caused by cancer in the chest or abdomen.

How It Works

Thiotepa is an alkylating agent. It attaches to the DNA inside cells and links the strands together so the cell cannot copy its DNA or divide. Rapidly dividing cells, such as cancer cells and bone marrow cells, are most affected. Before a transplant, this clears the existing bone marrow to make room for the new stem cells.

Dosage and Administration

Thiotepa is given by a doctor or nurse in hospital, usually as an infusion into a vein, and sometimes directly into the bladder or a body cavity. The dose is calculated from body size, the condition being treated and the other medicines in the treatment plan, and is as prescribed by the specialist. Blood counts are checked closely.

Interactions

• Other chemotherapy or radiotherapy can add to bone marrow and other toxic effects.
• Medicines that affect the liver enzymes CYP3A4 and CYP2B6 (such as Ketoconazole, Rifampicin, Phenytoin or Cyclophosphamide) may change Thiotepa levels.
• Live vaccines must not be given during treatment and for some time afterwards.

Tell the medical team about all medicines, herbal products and vaccines.

Contraindications

• Allergy to Thiotepa.
• Pregnancy and breastfeeding.
• Use with a yellow fever vaccine or other live virus or bacterial vaccines.

Side Effects

Very common effects include severe lowering of blood counts (raising the risk of infection, bleeding and anaemia), nausea, vomiting, mouth sores, diarrhoea, hair loss, tiredness and loss of appetite. Thiotepa passes out through the skin, so skin darkening, rash, itching, peeling or burning can occur, especially in skin folds and under dressings. Other possible effects include liver problems (including veno-occlusive disease, a blockage of small liver veins), lung problems, infertility, nerve effects and later cancers.

Get urgent medical help if you have a fever or chills, bleeding or easy bruising, severe mouth sores that stop you eating or drinking, rapid weight gain with a swollen tummy or yellow skin, breathlessness, confusion or seizures.

Pregnancy and Lactation

Thiotepa can harm an unborn baby and must not be used during pregnancy. Women and men should use effective contraception during treatment and for a period afterwards as advised by the doctor (often 6 months). Breastfeeding must be stopped. Thiotepa can cause permanent infertility; ask about sperm or egg storage before treatment.

Precautions and Warnings

• During treatment, shower and change clothing and bed linen at least twice a day, and change any dressings often, to reduce skin damage.
• Avoid contact with people who have infections; report any fever at once.
• Blood counts, liver and kidney function are monitored closely.
• Body fluids may contain the medicine; follow hospital advice on hygiene.

Overdose

Overdose mainly causes severe bone marrow damage. There is no specific antidote. Treatment is in hospital with close monitoring, blood transfusions, infection care and supportive treatment.

Therapeutic Class

Antineoplastic alkylating agent; conditioning agent for stem cell transplant.

Storage

Store unopened vials in a refrigerator at 2 to 8°C, do not freeze. It is stored and prepared by hospital staff as directed on the pack.