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Camptosar (Irinotecan Hydrochloride) - Side Effects and Adverse Reactions

 
 



ADVERSE REACTIONS

Clinical Studies Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

Common adverse reactions (≥30%) observed in combination therapy clinical studies are: nausea, vomiting, abdominal pain, diarrhea, constipation, anorexia, mucositis, neutropenia, leukopenia (including lymphocytopenia), anemia, thrombocytopenia, asthenia, pain, fever, infection, abnormal bilirubin, and alopecia.

Common adverse reactions (≥30%) observed in single agent therapy clinical studies are: nausea, vomiting, abdominal pain, diarrhea, constipation, anorexia, neutropenia, leukopenia (including lymphocytopenia), anemia, asthenia, fever, body weight decreasing, and alopecia.

Serious opportunistic infections have not been observed, and no complications have specifically been attributed to lymphocytopenia.

First-Line Combination Therapy

A total of 955 patients with metastatic colorectal cancer received the recommended regimens of irinotecan in combination with 5-FU/LV, 5-FU/LV alone, or irinotecan alone. In the two phase 3 studies, 370 patients received irinotecan in combination with 5-FU/LV, 362 patients received 5-FU/LV alone, and 223 patients received irinotecan alone [see Dosage and Administration (2) ].

In Study 1, 49 (7.3%) patients died within 30 days of last study treatment: 21 (9.3%) received irinotecan in combination with 5-FU/LV, 15 (6.8%) received 5-FU/LV alone, and 13 (5.8%) received irinotecan alone. Deaths potentially related to treatment occurred in 2 (0.9%) patients who received irinotecan in combination with 5-FU/LV (2 neutropenic fever/sepsis), 3 (1.4%) patients who received 5-FU/LV alone (1 neutropenic fever/sepsis, 1 CNS bleeding during thrombocytopenia, 1 unknown) and 2 (0.9%) patients who received irinotecan alone (2 neutropenic fever). Deaths from any cause within 60 days of first study treatment were reported for 15 (6.7%) patients who received irinotecan in combination with 5-FU/LV, 16 (7.3%) patients who received 5-FU/LV alone, and 15 (6.7%) patients who received irinotecan alone. Discontinuations due to adverse events were reported for 17 (7.6%) patients who received irinotecan in combination with 5FU/LV, 14 (6.4%) patients who received 5-FU/LV alone, and 26 (11.7%) patients who received irinotecan alone.

In Study 2, 10 (3.5%) patients died within 30 days of last study treatment: 6 (4.1%) received irinotecan in combination with 5-FU/LV and 4 (2.8%) received 5-FU/LV alone. There was one potentially treatment-related death, which occurred in a patient who received irinotecan in combination with 5-FU/LV (0.7%, neutropenic sepsis). Deaths from any cause within 60 days of first study treatment were reported for 3 (2.1%) patients who received irinotecan in combination with 5-FU/LV and 2 (1.4%) patients who received 5-FU/LV alone. Discontinuations due to adverse events were reported for 9 (6.2%) patients who received irinotecan in combination with 5FU/LV and 1 (0.7%) patient who received 5-FU/LV alone.

The most clinically significant adverse events for patients receiving irinotecan-based therapy were diarrhea, nausea, vomiting, neutropenia, and alopecia. The most clinically significant adverse events for patients receiving 5-FU/LV therapy were diarrhea, neutropenia, neutropenic fever, and mucositis. In Study 1, grade 4 neutropenia, neutropenic fever (defined as grade 2 fever and grade 4 neutropenia), and mucositis were observed less often with weekly irinotecan/5-FU/LV than with monthly administration of 5-FU/LV.

Tables 5 and 6 list the clinically relevant adverse events reported in Studies 1 and 2, respectively.

Table 5. Study 1: Percent (%) of Patients Experiencing Clinically Relevant Adverse Events in Combination Therapies 1
Adverse Event Study 1
Irinotecan + Bolus 5-FU/LV weekly × 4 every 6 weeks
N = 225
Bolus 5-FU/LV daily × 5 every 4 weeks
N = 219
Irinotecan weekly × 4 every 6 weeks
N = 223
Grade 1–4 Grade 3&4 Grade 1–4 Grade 3&4 Grade 1–4 Grade 3&4
TOTAL Adverse Events 100 53.3 100 45.7 99.6 45.7
GASTROINTESTINAL
  Diarrhea
    late 84.9 22.7 69.4 13.2 83.0 31.0
        grade 3 -- 15.1 -- 5.9 -- 18.4
        grade 4 -- 7.6 -- 7.3 -- 12.6
    early 45.8 4.9 31.5 1.4 43.0 6.7
  Nausea 79.1 15.6 67.6 8.2 81.6 16.1
  Abdominal pain 63.1 14.6 50.2 11.5 67.7 13.0
  Vomiting 60.4 9.7 46.1 4.1 62.8 12.1
  Anorexia 34.2 5.8 42.0 3.7 43.9 7.2
  Constipation 41.3 3.1 31.5 1.8 32.3 0.4
  Mucositis 32.4 2.2 76.3 16.9 29.6 2.2
HEMATOLOGIC
  Neutropenia 96.9 53.8 98.6 66.7 96.4 31.4
    grade 3 -- 29.8 -- 23.7 -- 19.3
    grade 4 -- 24.0 -- 42.5 -- 12.1
  Leukopenia 96.9 37.8 98.6 23.3 96.4 21.5
  Anemia 96.9 8.4 98.6 5.5 96.9 4.5
  Neutropenic fever -- 7.1 -- 14.6 -- 5.8
  Thrombocytopenia 96.0 2.6 98.6 2.7 96.0 1.7
  Neutropenic infection -- 1.8 -- 0 -- 2.2
BODY AS A WHOLE
  Asthenia 70.2 19.5 64.4 11.9 69.1 13.9
  Pain 30.7 3.1 26.9 3.6 22.9 2.2
  Fever 42.2 1.7 32.4 3.6 43.5 0.4
  Infection 22.2 0 16.0 1.4 13.9 0.4
METABOLIC & NUTRITIONAL
  Bilirubin 87.6 7.1 92.2 8.2 83.9 7.2
DERMATOLOGIC
  Exfoliative dermatitis 0.9 0 3.2 0.5 0 0
  Rash 19.1 0 26.5 0.9 14.3 0.4
  Alopecia 2 43.1 -- 26.5 -- 46.1 --
RESPIRATORY
  Dyspnea 27.6 6.3 16.0 0.5 22.0 2.2
  Cough 26.7 1.3 18.3 0 20.2 0.4
  Pneumonia 6.2 2.7 1.4 1.0 3.6 1.3
NEUROLOGIC
  Dizziness 23.1 1.3 16.4 0 21.1 1.8
  Somnolence 12.4 1.8 4.6 1.8 9.4 1.3
  Confusion 7.1 1.8 4.1 0 2.7 0
CARDIOVASCULAR
  Vasodilatation 9.3 0.9 5.0 0 9.0 0
  Hypotension 5.8 1.3 2.3 0.5 5.8 1.7
  Thromboembolic events 3 9.3 -- 11.4 -- 5.4 --

1 Severity of adverse events based on NCI CTC (version 1.0)
2 Complete hair loss = Grade 2
3 Includes angina pectoris, arterial thrombosis, cerebral infarct, cerebrovascular accident, deep thrombophlebitis, embolus lower extremity, heart arrest, myocardial infarct, myocardial ischemia, peripheral vascular disorder, pulmonary embolus, sudden death, thrombophlebitis, thrombosis, vascular disorder.

Table 6. Study 2: Percent (%) of Patients Experiencing Clinically Relevant Adverse Events in Combination Therapies 1
Study 2
Adverse Event Irinotecan + 5-FU/LV infusional days 1&2 every 2 weeks
N = 145
5-FU/LV infusional days 1&2 every 2 weeks
N = 143
Grades 1–4 Grades 3&4 Grades 1–4 Grades 3&4
TOTAL Adverse Events 100 72.4 100 39.2
GASTROINTESTINAL
  Diarrhea
    late 72.4 14.4 44.8 6.3
        grade 3 -- 10.3 -- 4.2
        grade 4 -- 4.1 -- 2.1
  Cholinergic syndrome 2 28.3 1.4 0.7 0
  Nausea 66.9 2.1 55.2 3.5
  Abdominal pain 17.2 2.1 16.8 0.7
  Vomiting 44.8 3.5 32.2 2.8
  Anorexia 35.2 2.1 18.9 0.7
  Constipation 30.3 0.7 25.2 1.4
  Mucositis 40.0 4.1 28.7 2.8
HEMATOLOGIC
  Neutropenia 82.5 46.2 47.9 13.4
    grade 3 -- 36.4 -- 12.7
    grade 4 -- 9.8 -- 0.7
  Leukopenia 81.3 17.4 42.0 3.5
  Anemia 97.2 2.1 90.9 2.1
  Neutropenic fever -- 3.4 -- 0.7
  Thrombocytopenia 32.6 0 32.2 0
  Neutropenic infection -- 2.1 -- 0
BODY AS A WHOLE
  Asthenia 57.9 9.0 48.3 4.2
  Pain 64.1 9.7 61.5 8.4
  Fever 22.1 0.7 25.9 0.7
  Infection 35.9 7.6 33.6 3.5
METABOLIC AND NUTRITIONAL
  Bilirubin 19.1 3.5 35.9 10.6
DERMATOLOGIC
  Hand and foot syndrome 10.3 0.7 12.6 0.7
  Cutaneous signs 17.2 0.7 20.3 0
  Alopecia 3 56.6 -- 16.8 --
RESPIRATORY
  Dyspnea 9.7 1.4 4.9 0
CARDIOVASCULAR
  Hypotension 3.4 1.4 0.7 0
  Thromboembolic events 4 11.7 -- 5.6 --
1 Severity of adverse events based on NCI CTC (version 1.0)
2 Includes rhinitis, increased salivation, miosis, lacrimation, diaphoresis, flushing, abdominal cramping or diarrhea (occurring during or shortly after infusion of irinotecan)
3 Complete hair loss = Grade 2
4 Includes angina pectoris, arterial thrombosis, cerebral infarct, cerebrovascular accident, deep thrombophlebitis, embolus lower extremity, heart arrest, myocardial infarct, myocardial ischemia, peripheral vascular disorder, pulmonary embolus, sudden death, thrombophlebitis, thrombosis, vascular disorder.

Second-Line Single-Agent Therapy

Weekly Dosage Schedule

In three clinical studies evaluating the weekly dosage schedule, 304 patients with metastatic carcinoma of the colon or rectum that had recurred or progressed following 5-FU-based therapy were treated with CAMPTOSAR. Seventeen of the patients died within 30 days of the administration of CAMPTOSAR; in five cases (1.6%, 5/304), the deaths were potentially drug-related. One of the patients died of neutropenic sepsis without fever. Neutropenic fever occurred in nine (3.0%) other patients; these patients recovered with supportive care.

One hundred nineteen (39.1%) of the 304 patients were hospitalized because of adverse events; 81 (26.6%) patients were hospitalized for events judged to be related to administration of CAMPTOSAR. The primary reasons for drug-related hospitalization were diarrhea, with or without nausea and/or vomiting (18.4%); neutropenia/leukopenia, with or without diarrhea and/or fever (8.2%); and nausea and/or vomiting (4.9%).

The first dose of at least one cycle of CAMPTOSAR was reduced for 67% of patients who began the studies at the 125-mg/m2 starting dose. Within-cycle dose reductions were required for 32% of the cycles initiated at the 125-mg/m2 dose level. The most common reasons for dose reduction were late diarrhea, neutropenia, and leukopenia. Thirteen (4.3%) patients discontinued treatment with CAMPTOSAR because of adverse events. The adverse events in Table 7 are based on the experience of the 304 patients enrolled in the three studies described in CLINICAL STUDIES (14.1).

Table 7. Adverse Events Occurring in >10% of 304 Previously Treated Patients with Metastatic Carcinoma of the Colon or Rectum 1
% of Patients Reporting
Body System & Event NCI Grades 1–4 NCI Grades 3 & 4
GASTROINTESTINAL
  Diarrhea (late) 2 88 31
    7–9 stools/day (grade 3) (16)
    ≥10 stools/day (grade 4) (14)
  Nausea 86 17
  Vomiting 67 12
  Anorexia 55 6
  Diarrhea (early) 3 51 8
  Constipation 30 2
  Flatulence 12 0
  Stomatitis 12 1
  Dyspepsia 10 0
HEMATOLOGIC
  Leukopenia 63 28
  Anemia 60 7
  Neutropenia 54 26
    500 to <1000/mm3 (grade 3) (15)
    <500/mm3 (grade 4) (12)
BODY AS A WHOLE
  Asthenia 76 12
  Abdominal cramping/pain 57 16
  Fever 45 1
  Pain 24 2
  Headache 17 1
  Back pain 14 2
  Chills 14 0
  Minor infection 4 14 0
  Edema 10 1
  Abdominal enlargement 10 0
METABOLIC AND NUTRITIONAL
  ↓ Body weight 30 1
  Dehydration 15 4
  ↑ Alkaline phosphatase 13 4
  ↑ SGOT 10 1
DERMATOLOGIC
  Alopecia 60 NA 5
  Sweating 16 0
  Rash 13 1
RESPIRATORY
  Dyspnea 22 4
  ↑ Coughing 17 0
  Rhinitis 16 0
NEUROLOGIC
  Insomnia 19 0
  Dizziness 15 0
CARDIOVASCULAR
  Vasodilation (flushing) 11 0

1 Severity of adverse events based on NCI CTC (version 1.0)
2 Occurring >24 hours after administration of CAMPTOSAR
3 Occurring ≤24 hours after administration of CAMPTOSAR
4 Primarily upper respiratory infections
5 Not applicable; complete hair loss = NCI grade 2

Once-Every-3-Week Dosage Schedule

A total of 535 patients with metastatic colorectal cancer whose disease had recurred or progressed following prior 5-FU therapy participated in the two phase 3 studies: 316 received irinotecan, 129 received 5-FU, and 90 received best supportive care. Eleven (3.5%) patients treated with irinotecan died within 30 days of treatment. In three cases (1%, 3/316), the deaths were potentially related to irinotecan treatment and were attributed to neutropenic infection, grade 4 diarrhea, and asthenia, respectively. One (0.8%, 1/129) patient treated with 5-FU died within 30 days of treatment; this death was attributed to grade 4 diarrhea.

Hospitalizations due to serious adverse events occurred at least once in 60% (188/316) of patients who received irinotecan, 63% (57/90) who received best supportive care, and 39% (50/129) who received 5-FU-based therapy. Eight percent of patients treated with irinotecan and 7% treated with 5-FU-based therapy discontinued treatment due to adverse events.

Of the 316 patients treated with irinotecan, the most clinically significant adverse events (all grades, 1–4) were diarrhea (84%), alopecia (72%), nausea (70%), vomiting (62%), cholinergic symptoms (47%), and neutropenia (30%). Table 8 lists the grade 3 and 4 adverse events reported in the patients enrolled to all treatment arms of the two studies described in CLINICAL STUDIES (14.1).

Table 8: Percent Of Patients Experiencing Grade 3 & 4 Adverse Events In Comparative Studies Of Once-Every-3-Week Irinotecan Therapy 1
Study 1 Study 2
Adverse Event Irinotecan
N = 189
BSC 2
N = 90
Irinotecan
N = 127
5-FU
N = 129
TOTAL Grade 3/4
Adverse Events
79 67 69 54
GASTROINTESTINAL
  Diarrhea 22 6 22 11
  Vomiting 14 8 14 5
  Nausea 14 3 11 4
  Abdominal pain 14 16 9 8
  Constipation 10 8 8 6
  Anorexia 5 7 6 4
  Mucositis 2 1 2 5
HEMATOLOGIC
  Leukopenia/Neutropenia 22 0 14 2
  Anemia 7 6 6 3
  Hemorrhage 5 3 1 3
  Thrombocytopenia 1 0 4 2
Infection
  without grade 3/4 neutropenia 8 3 1 4
  with grade 3/4 neutropenia 1 0 2 0
Fever
  without grade 3/4 neutropenia 2 1 2 0
  with grade 3/4 neutropenia 2 0 4 2
BODY AS A WHOLE
  Pain 19 22 17 13
  Asthenia 15 19 13 12
METABOLIC AND NUTRITIONAL
  Hepatic 3 9 7 9 6
DERMATOLOGIC
  Hand and foot syndrome 0 0 0 5
  Cutaneous signs 4 2 0 1 3
RESPIRATORY 5 10 8 5 7
NEUROLOGIC 6 12 13 9 4
CARDIOVASCULAR 7 9 3 4 2
OTHER 8 32 28 12 14

1 Severity of adverse events based on NCI CTC (version 1.0)
2 BSC = best supportive care
3 Hepatic includes events such as ascites and jaundice
4 Cutaneous signs include events such as rash
5 Respiratory includes events such as dyspnea and cough
6 Neurologic includes events such as somnolence
7 Cardiovascular includes events such as dysrhythmias, ischemia, and mechanical cardiac dysfunction
8 Other includes events such as accidental injury, hepatomegaly, syncope, vertigo, and weight loss

The incidence of akathisia in clinical trials of the weekly dosage schedule was greater (8.5%, 4/47 patients) when prochlorperazine was administered on the same day as CAMPTOSAR than when these drugs were given on separate days (1.3%, 1/80 patients). The 8.5% incidence of akathisia, however, is within the range reported for use of prochlorperazine when given as a premedication for other chemotherapies.

Postmarketing Experience

The following adverse reactions have been identified during post approval use of CAMPTOSAR. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Myocardial ischemic events have been observed following irinotecan therapy. Thromboembolic events have been observed in patients receiving CAMPTOSAR.

Symptomatic pancreatitis, asymptomatic pancreatic enzyme elevation have been reported. Increases in serum levels of transaminases (i.e., AST and ALT) in the absence of progressive liver metastasis have been observed.

Hyponatremia, mostly with diarrhea and vomiting, has been reported.

Transient dysarthria has been reported in patients treated with CAMPTOSAR; in some cases, the event was attributed to the cholinergic syndrome observed during or shortly after infusion of irinotecan.

Interaction between irinotecan and neuromuscular blocking agents cannot be ruled out. Irinotecan has anticholinesterase activity, which may prolong the neuromuscular blocking effects of suxamethonium and the neuromuscular blockade of non-depolarizing drugs may be antagonized.



REPORTS OF SUSPECTED CAMPTOSAR SIDE EFFECTS / ADVERSE REACTIONS

Below is a sample of reports where side effects / adverse reactions may be related to Camptosar. The information is not vetted and should not be considered as verified clinical evidence.

Possible Camptosar side effects / adverse reactions in 63 year old male

Reported by a health professional (non-physician/pharmacist) from Japan on 2011-10-03

Patient: 63 year old male

Reactions: Hepatic Failure

Suspect drug(s):
Camptosar
    Indication: Colon Cancer

Levoleucovorin Calcium
    Indication: Colon Cancer

Oxaliplatin
    Indication: Colon Cancer

Other drugs received by patient: Efudex; Avastin



Possible Camptosar side effects / adverse reactions in 79 year old male

Reported by a physician from Japan on 2011-10-04

Patient: 79 year old male weighing 51.0 kg (112.2 pounds)

Reactions: Metabolic Acidosis, Hypotension, Disseminated Intravascular Coagulation, Respiratory Alkalosis, Pyrexia, Ileus Paralytic, Haemoglobin Decreased, Respiratory Failure, Neutropenia, Thrombocytopenia, Leukopenia

Adverse event resulted in: life threatening event, hospitalization

Suspect drug(s):
Camptosar
    Dosage: 140 mg/body (95.2 mg/m2), unk
    Start date: 2010-01-05
    End date: 2010-01-05

Camptosar
    Dosage: 224 mg/body (152.4 mg/m2), unk
    Indication: Colorectal Cancer
    Start date: 2009-09-03
    End date: 2009-09-03

Efudex
    Dosage: 600 mg/body, (408.2 mg/m2)
    Indication: Colorectal Cancer
    Start date: 2009-09-03
    End date: 2009-09-03

Erbitux
    Dosage: 605 mg/body (411.6 mg/m2), unk
    Indication: Colorectal Cancer
    Start date: 2009-09-03
    End date: 2009-09-03

Erbitux
    Dosage: 375 mg/body (255.1 mg/m2), unk
    Start date: 2009-09-10
    End date: 2009-09-10

Erbitux
    Dosage: 280 mg/body (190.5 mg/m2), unk
    Start date: 2010-01-05
    End date: 2010-01-12

Efudex
    Dosage: 3600 mg/body/d1-2, (2449 mg/m2/d1-2)
    Start date: 2009-09-03
    End date: 2009-09-03

Other drugs received by patient: Albumin Normal Human Serum; Levoleucovorin Calcium; Midazolam HCL; RED Blood Cells, Leucocyte Depleted



Possible Camptosar side effects / adverse reactions in 72 year old male

Reported by a health professional (non-physician/pharmacist) from France on 2011-10-05

Patient: 72 year old male

Reactions: Paraesthesia

Adverse event resulted in: disablity

Suspect drug(s):
Camptosar
    Dosage: unk
    Indication: Colorectal Cancer Metastatic
    Start date: 2010-11-30
    End date: 2011-05-25

Eloxatin
    Dosage: 140 mg, cyclic
    Indication: Colorectal Cancer Metastatic
    Start date: 2010-10-18
    End date: 2011-04-28

Fluorouracil
    Dosage: 700 mg, cyclic
    Indication: Colorectal Cancer Metastatic
    Start date: 2010-10-18
    End date: 2011-05-25

Avastin
    Dosage: 285 mg, cyclic
    Indication: Colorectal Cancer Metastatic
    Start date: 2010-10-18
    End date: 2011-05-25

Other drugs received by patient: Folic Acid; Coumadin; Zolpidem; Xanax



See index of all Camptosar side effect reports >>

Drug label data at the top of this Page last updated: 2014-05-06

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