Teniposide is a chemotherapy drug that is given as a treatment for some types of cancer. It can be used on its own or in combination with other chemotherapy drugs to treat adult and childhood leukaemias, types of lymphoma, Hodgkin's lymphoma and childhood neuroblastoma. It may also be used for some other types of cancer.

Although teniposide has been in use for many years, it is currently not licensed for use in the UK. However, the drug may be given to individual patients who have been selected by their doctor as suitable (this is called named-patient prescribing).

This information describes teniposide, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

Teniposide is a colourless fluid.

Teniposide is given by injection:

• into a vein (intravenously) through a fine tube (cannula) placed into the vein, usually in the back of the hand
• through a fine plastic tube that is inserted under the skin into a vein near the collarbone (central line)
• into a fine tube that is inserted into a vein in the crook of your arm (PICC line).

Chemotherapy is usually given as a course of several sessions (or cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer for which you are being treated. Your nurse or doctor will discuss your treatment plan with you.

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given teniposide, and may be different if you are having more than one chemotherapy drug.

We have outlined the most common side effects as well as rarer ones, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor, chemotherapy nurse or pharmacist.

Feeling sick (nausea) and being sick (vomiting) If you do feel sick this may begin a few hours after the treatment is given and last for up to a day. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting. If the sickness isn't controlled, or continues, tell your doctor; they can prescribe other anti-sickness drugs which may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Lowered resistance to infection Teniposide can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straight away if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally, it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Teniposide can reduce the production of platelets, which help the blood to clot. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with teniposide you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these symptoms are a problem.

Diarrhoea This can usually be easily controlled with medicine, but tell your doctor if it is severe or if it continues. It's important to drink plenty of fluids if you have diarrhoea.

Sore mouth and ulcers Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems as special mouthwashes and medicines to prevent or clear any mouth infection can be prescribed.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after treatment.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Allergic reaction Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, redness of the face, dizziness, headache, breathlessness and anxiety. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these signs.

Hair loss If this happens it usually starts 2–3 weeks after the first dose of teniposide, although it may occur earlier. Your hair is most likely to just get thinner, but it could fall out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and all your hair will grow again once treatment ends. Your nurse can give you advice about coping with hair loss.

Low blood pressure This may sometimes be experienced whilst the drug is given. Let your doctor know if you feel faint or dizzy.

Injection site While teniposide is being given, it can cause pain at the place where the injection is given, or along the vein. If you feel pain tell the doctor or nurse and they can slow the drip down.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines Some medicines (including those you can  buy from a shop or chemist) can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking teniposide as it may harm the developing foetus. It is important to use effective contraception whilst taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

This section is based on our Teniposide factsheet which has been compiled using information from a number of reliable sources, including:

• The Chemotherapy Source Book (4th edition). Ed. Perry, Lippincott Williams and Wilkins, 2007.
• The Cancer Chemotherapy Handbook (6th edition). Ed. D.S Fischer et al, Mosby, 2003.
• Cancer Chemotherapy Handbook (2nd edition). D.C Baquiran, Lippincott’s, 2001.

For further references, please see the general bibliography.