BIOMEDICINE – ANTINEOPLASTIC: Plant Alkaloids
ACTION: damages DNA, causes cell death.
INDICATIONS: Treatment of metastatic carcinoma of colon or rectum.
OFF-LABEL: Non– small-cell lung cancer; small-cell lung cancer; CNS tumor; cervical, gastric, pancreatic, ovarian, esophageal cancer; Ewing’s sarcoma; brain tumor.
PHARMACOKINETICS: Originates from Camptotheca acuminata (Happy Tree) Metabolized in liver. Excreted in urine and eliminated by biliary route.
Half- life: 6–12 hours; metabolite, 10–20 hrs.
SIDE EFFECTS:
Expected: (64%–32%) Nausea, alopecia, vomiting, diarrhea.
Frequent: (29%–22%) Constipation, fatigue, fever, asthenia, skeletal pain, abdominal pain, dyspnea.
Occasional: (19%–16%) Anorexia, headache, stomatitis, rash.
ADVERSE EFFECTS/ TOXIC REACTIONS: anemia, leukopenia, thrombocytopenia, and neutropenia, sepsis occur frequently. Can induce both early and late forms of severe diarrhea. Early diarrhea (during or shortly after administration) accompanied by salivation, rhinitis, lacrimation, diaphoresis, flushing. Late diarrhea (occurring more than 24 hours after administration) can be prolonged and life-threatening. May produce severe, profound myelosuppression.
Caution: Avoid live vaccines during treatment.
INTERACTIONS:
DRUG: CYP3A4 inducers (e.g., phenyt- oin, phenobarbital, carbamazepine) decrease concentration/effects. CYP3A4 inhibitors (e.g., ketoconazole) increase concentration.
HERBAL: St. John’s wort may decrease irinotecan effectiveness.
FOOD: None known.
LAB VALUES: May increase AST, serum alkaline phosphatase. May decrease Hgb, leukocytes, platelets.
(Camptosar)
TCM – Chapter 7: Interior-Warming
Enters: LI, Lu, Sp, Liv,
Temperature: hot
Taste: acrid, salty, toxic
ACTION: warm interior, transform phlegm, move Qi.
INDICATIONS: soften masses Ji [积],`
Tongue: pale, pink, dry coat.
Pulse: wiry, slippery
RATIONALE: It’s salty taste softens malignant masses created from intertangled Qi, Blood and Phlegm thus allowing its hot temperature to dry Phlegm and toxic nature to break Qi and Blood. Its acrid taste facilitates movement of Qi thus promoting gut motility to expel excess.
CAUTION: Excess Damp-Heat accumulation or Sp Qi vacuity
MODIFICATIONS: To counteract side effect of damp-heat diarrhea add Huang Qin. To tonify Sp Qi add Da Zao. If both are present and patient has severe damp-heat diarrhea add Huang Qin Tang, which has proven effectiveness in clinical studies.