Efficacy of a toxicity-adjusted topotecan therapy in recurrent small-cell lung cancer

¹ Ludwig-Maximilians-University, Klinikum der Universität, Innenstadt, Ziemssenstr. 1, 80336 München
² Krankenhaus Großhansdorf, Dept of Pneumology and Thoracic Surgery, Wöhrendamm 80, 22927 Großhansdorf
³ Robert-Koch-Klinik, Dept of Internal Medicine, N.-Rumjanzew-Str. 100, 04207 Leipzig
⁴ Asklepios Fachkliniken, Robert-Koch-Allee 2, 82131 Gauting
⁵ St. Vincentius-Krankenhäuser, Dept of Internal Medicine, Südenstr. 32, 76137 Karlsruhe
⁶ St. Franziskus Hospital, Dept. Of Hematology and Oncology, Waldstr. 17, 24939 Flensburg
⁷ University of Bonn, Medical Dept, Sigmund-Freud-Str. 25, 53105 Bonn
⁸ Clemenshospital, Dept of Internal Medicine II, Düesbergweg 124, 48153 Münster

^* To whom correspondence should be addressed. E-mail: Huber{at}med.uni-muenchen.de.

	Abstract

A prospective multi-center trial investigated whether topotecan given at a starting dose of 1.25 mg·m^-2 with individual dose adjustment can improve safety in patients with relapsed/refractory SCLC without loss of efficacy.

Patients received topotecan intravenously on days 1-5 every 21 days up to 6 courses. In the absence of relevant hematotoxicities topotecan was escalated to 1.5 mg·m^-2 and reduced to 1.0 mg·m^-2 in case of severe hematotoxicities.

Of 170 recruited patients 73.2% had stage IV disease, 63.4% had platinum containing pre-treatment. Patients received a total of 521 courses. In 72.6% of those courses the dose remained at 1.25 mg·m^-2; in 9.1% it was reduced and in 18.3% escalated. Overall response rate was 14.1% including one complete response, 28.8% had stable disease. Median duration of response was 13.6 weeks, median survival 23.4 weeks. Clinical benefit was obvious for sensitive as well as for refractory patients. Hematotoxicity of grade 3 or 4 was clearly lower compared to standard dose of 1.5 mg·m^-2.

In conclusion, topotecan in a dose of 1.25 mg·m^-2 appears to be as effective as the dose of 1.5 mg·m^-2 with reduced toxicity. Since patients with recurrent SCLC have a poor prognosis they especially benefit from the good tolerability.

This article has been cited by other articles:

				G A Silvestri and S G Spiro Carcinoma of the bronchus 60 years later Postgrad. Med. J., April 1, 2008; 84(990): 182 - 187. [Full Text] [PDF]

				M. O'Brien, J. Eckardt, and R. Ramlau Recent Advances with Topotecan in the Treatment of Lung Cancer Oncologist, October 1, 2007; 12(10): 1194 - 1204. [Abstract] [Full Text] [PDF]

				G A Silvestri and S G Spiro Carcinoma of the bronchus 60 years later. Thorax, December 1, 2006; 61(12): 1023 - 1028. [Full Text] [PDF]