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irinotecan intravenous colon cancer small cell lung cisplatin fluorouracil diarrhea vomiting bone marrow suppression hair loss shortness breath fever blood clots inflammation allergic reactions topoisomerase inhibitor enzyme dna damage camptotheca acuminata camptothecin chinese ornamental tree immunosuppression pathway metabolism cytochrome p450 elimination bile rendering chemotherapy chemotherapy regimen antineoplastic chemo ctx cancer treatment anti-cancer anticancer oncology mitosis inhibit cytotoxic myelosuppression targeted therapies topoisomerase antimetabolite emetogenic chemotherapy-induced nausea cinv