In August 2005, NICE (National Institute for Health and Clinical Excellence) issued guidance for doctors on the use of certain chemotherapy drugs for advanced bowel cancer; including irinotecan.

They recommend that people with bowel cancer that has spread have either 5FU (fluorouracil), 5FU with Irinotecan or 5FU with Oxaliplatin. For people who have had 5FU before (or for whom 5FU is not suitable), Irinotecan can be used on its own.

Like other chemotherapy drugs irinotecan works by interfering with the process of cell division. Whilst this can help control cancers it also interferes with the growth of normal cells and so leads to some side effects. With irinotecan the following are some of the commoner problems that people can have:

• some people get a reaction during the infusion itself with sweating, increased salivation, abdominal cramps, diarrhoea and weakness. This can be controlled with a simple injection and often this is given as a precaution before the infusion to avoid the risk of a reaction.
• delayed diarrhoea occurring a few days after chemotherapy is quite common. Usually it is controlled by simple tablets which you will be given to take home with you at the time of the infusion. Occasionally the diarrhoea can be very severe and it is important that if the tablets do not rapidly control it, then you contact your doctors immediately so that they can take further action.
• sickness is possible with irinotecan for a day or so after the infusion, but with modern day anti-sickness drugs this can often be completely prevented or kept to a minimum and is not usually troublesome.
• hair loss does occur with irinotecan, starting about 3 to 4 weeks after the first infusion. The hair loss is usually partial, although the hair always grows again after treatment. Many chemotherapy clinics offer scalp cooling immediately before and during each infusion, which can reduce the risk of hair loss, so do discuss this with your medical team.
• temporary reduction in bone marrow function can develop a few days after each infusion and last for a week or two (because of this you will have a blood test before each infusion to check the bone marrow has fully recovered). The reduced bone marrow function lowers the number of white blood cells in your blood and this makes you more liable to develop infections. Because of this you will be warned to contact the medical team immediately if you develop a temperature above 38°C (100.5°F) during the time you are having treatment.