irinotecan + cefpodoxime

Irinotecan + cefpodoxime is a combination regimen used primarily in pediatric oncology research to optimize the administration of irinotecan, a topoisomerase I inhibitor, by co-administering it with oral cefpodoxime, a third-generation cephalosporin antibiotic. Irinotecan is an antineoplastic agent that acts as a prodrug; its active metabolite SN-38 inhibits DNA topoisomerase I, leading to DNA damage and cell death. A major dose-limiting toxicity of irinotecan is delayed diarrhea, which results from SN-38-induced mucosal injury in the gastrointestinal tract. Oral cephalosporins like cefpodoxime are used prophylactically to reduce this toxicity by suppressing intestinal beta-glucuronidase-producing bacteria that reactivate SN-38G (the inactive glucuronide conjugate) back into toxic SN-38 in the gut lumen. This strategy allows for higher tolerated doses of irinotecan on protracted schedules without increasing severe diarrhea risk[1][2][9]. The combination has been studied mainly in children and adolescents with refractory solid tumors.