Thiotepa (Thiophosphoramide)

Please read this information in conjunction with our general information on chemotherapy, and with the information in relation to your specific type of cancer.

• What is thiotepa ?
• What does it look like ?
• How is it given?
• Side effects
• Less common side effects
• Additional information
• References

What is thiotepa ?

Thiotepa is a chemotherapy drug used for the treatment of various types of cancer. It may used as a treatment on its own or in combinatin with other chemotherapy drugs. It is most commonly used to treat breast and ovarian cancer and for the local treatment of bladder and pleural cancer.

What does it look like?

It is a colourless fluid when dissolved from a powder.

How is it given?

• It can be given as an injection or infusion intravenous into a peripheral cannula or central line.
• It can be given as an injection into the muscle intramuscular .
• It can be given directly into the bladder intracavitary .
• It can be given by injection into the fluid around the spinal cord by a lumbar puncture or via a a port which is inerted under the scalp Ommaya resevoir , which is called intrathecal chemotherapy. This procedure will be carried out by specially trained doctors and nurses and may be carried out in a special area.

Side effects

The side effects mentioned below may not affect everyone, as each patient's reaction to chemotherapy is different. It will also depend on how many chemotherapy drugs you are receiving. If you experience any side effects that you think are related to your chemotherapy, please discuss them with your oncology doctor or chemotherapy nurse.

Infection

You will be more prone to infection as thiotepa affects your white cell production from the bone marrow. This effect usually occurs about 10-14 days after your chemotherapy. You will have blood tests to check your levels before every chemotherapy dose to ensure your blood levels have returned to normal. Occasionally your treatment may be delayed until your blood levels come back to normal. If you notice any signs of infection visit your doctor for assessment.
You should contact your doctor or the Oncology Unit straight away if you if you have a sore throat,cough, pain passing urine, redness and swelling at e.g. at a catheter site. Or have a temperature of 38 degrees° C or greater.

Bruising

Thiotepa can also affect the production of platelets, which can cause bleeding or bruising. Inform your doctor if you notice any unexplained bleeding or bruising.

Anaemia

You may feel lethargic and breathless due to a reduction in your red cells caused by thiotepa. Inform your doctor if you are feeling these effects.

Nausea and vomiting

Thiotepa   can make you feel sick nausea or to to be sick / vomit  . It may occur a few hours after you receive your first dose of treatment and can last for a number of days. Your doctor will prescribe some medications to prevent this anti-emetics  .If you continue to feel sick it is important to inform your doctor.

Fatigue

You may feel very tired. This can last for a few months after your treatment. Inform your doctor or nurse of how you are feeling.

Less common side-effects

Hair loss (alopecia)

You may loose all your hair or it may just thin out. This usually happens after your first course of chemotherapy. This is temporary and your hair will grow back.

Sore mouth

You may develop a sore mouth or ulcers due to your chemotherapy. You will be prescribed some mouthwashes. Inform your doctor or nurse if your mouth becomes sore or you develop ulcers. You may also experience some taste changes, which will resolve after you finish your treatment.

Skin changes

You may find that your skin is darker, this is due to an over production of pigment. This returns to normal when your chemotherapy is finished.

Allergic reactions

Some patients may experience some breathlessness, headaches; back pain, skin rash or facial swelling once the drug has been given. If you experience any of these effects tell your doctor or nurse immediately. You will be monitored very closely for signs of allergic reaction during your treatment. You may receive a drug before your chemotherapy to prevent this allergic reaction occurring.

Phlebitis

You may experience a pain or swelling at the injection site (cannula) in you hand or arm while you are having your thiotepa treatment. You should inform your nurse or doctor if this occurs.

Additional information

The side effects mentioned above usually occur when the chemotherapy is given into the vein (intravenously), they are less common when the chemotherapy is given in other ways. When thiotepa is given into the bladder it may irritate the lining of the bladder wall and you will have to pass urine more often (cystitis). You should inform our doctor if this occurs as medications can be given to reduce this feeling. When it is given around the spinal cord (intratheally) you may experience headaches and dizziness.

Fertility

It is important to discuss this with your doctor as your fertility may be affected by thiotepa.

Contraception

It is important to use a reliable form of contraception while you are on treatment and for at least two years after your treatment has completed. It is not advised to get pregnant or father a child while on treatment as the drugs may affect the foetus.

Other medications

It is important to inform your doctor of any medications that you are taking, including over the counter medications or herbal drugs as they can interfere with some chemotherapy drugs.

References

• The Chemotherapy Source Book (2nd edition). M. Perry, Lippincott, Williams and Wilkins, 1997.
• British National Formulary (53rd edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, March 2007.
• The Cytotoxics Handbook (3rd edition). M. Allwood, A. Stanley and P. Wright, Radcliffe Medical Press, Oxford and New York, 1997.
• Cancer Chemotherapy Handbook. T. Dorr and W.L. Fritz, Kimpton Medical Publications, London, 1980.

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