Irinotecan hydrochloride: drug profile and nursing implications of a topoisomerase I inhibitor in patients with advanced colorectal cancer.

PURPOSE/OBJECTIVES: To review the drug profile and nursing implications of the topoisomerase I inhibitor irinotecan hydrochloride.

DATA SOURCES

Published articles, abstracts, professional communications, drug manufacturer, and professional clinical experience with irinotecan clinical studies.

DATA SYNTHESIS

Irinotecan, one of the first topoisomerase I inhibitors to gain wide clinical use, has exhibited activity in several malignancies. In June 1996, the United States Food and Drug Administration approved its use in patients with metastatic colorectal cancer refractory to fluorouracil (5-FU)-based therapy. The recommended starting dose is 125 mg/m2 administered as a weekly infusion for four weeks followed by a two-week rest period. The most common and clinically significant adverse events include diarrhea, neutropenia, and nausea and vomiting. Other adverse events include alopecia and fatigue.

CONCLUSIONS

Irinotecan has significant activity in patients with 5-FU-refractory colorectal cancer. This drug is well tolerated and easily administered in an outpatient setting. The most common adverse events are well characterized and are reversible upon treatment discontinuation or dosage reduction. In particular, diarrhea, the most common toxicity, is manageable with use of appropriate dose modification and rigorous administration of loperamide at the first signs of diarrhea.

IMPLICATIONS FOR NURSING PRACTICE

Nurses need to focus on identifying and managing adverse effects based on individual patient tolerance. Nurses have an important role to play in patient education and follow up in order to minimize toxicity. Patient care concerns include management of diarrhea and nausea and vomiting, neutropenia with related risk of infection, and fluid and electrolyte imbalances.