title: Phase II trial of topotecan administered as 72-hour continuous infusion in children with refractory solid tumors: a collaborative Pediatric Branch, National Cancer Institute, and Children's Cancer Group Study.
abstract: The antitumor activity of topotecan administered as a 72-h continuous i.v. infusion was evaluated in children with refractory neuroblastoma and sarcomas of soft tissue and bone. We also attempted to increase the dose intensity of topotecan by including an intrapatient dose escalation in the trial design. Ninety-three children (85 eligible and evaluable for response) with recurrent or refractory neuroblastoma, osteosarcoma, Ewing's sarcoma/peripheral neuroectodermal tumor, rhabdomyosarcoma, or other soft-tissue sarcomas received topotecan administered as a 72-h i.v. infusion every 21 days. The initial dose was 1.0 mg/m2/day, with subsequent intrapatient dose escalation to 1.3 mg/m2/day for those patients who did not experience dose-limiting toxicity after their first cycle of topotecan. There was one complete response in a patient with neuroblastoma (n = 26) and one partial response in a patient with Ewing's sarcoma/peripheral neuroectodermal tumor (n = 25). No complete or partial responses were observed in 17 patients with osteosarcoma, 15 patients with rhabdomyosarcoma, or 2 patients with other soft-tissue sarcomas; however, 8 patients had prolonged (15-48 weeks) stable disease while receiving topotecan. Topotecan was well tolerated. The most commonly observed toxicities were myelosuppression (dose-limiting) and nausea and vomiting. Intrapatient dose escalations were performed in 68% of the patients who received more than one cycle of topotecan, and 1.3 mg/m2/day was tolerated by 79% of the patients who received the higher dose and were evaluable for hematological toxicity. In conclusion, topotecan administered as a 72-h continuous infusion every 21 days is inactive (objective response rate, < 20%) in children with refractory or recurrent neuroblastoma and sarcomas of soft tissue or bone.
authors.affiliation: Pediatric Branch, National Cancer Institute, Bethesda, Maryland 20892, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Blaney
authors.forename: M N
authors.initials: MN
authors.lastname: Needle
authors.forename: A
authors.initials: A
authors.lastname: Gillespie
authors.forename: J K
authors.initials: JK
authors.lastname: Sato
authors.forename: G H
authors.initials: GH
authors.lastname: Reaman
authors.forename: S L
authors.initials: SL
authors.lastname: Berg
authors.forename: P C
authors.initials: PC
authors.lastname: Adamson
authors.forename: M D
authors.initials: MD
authors.lastname: Krailo
authors.forename: W A
authors.initials: WA
authors.lastname: Bleyer
authors.forename: D G
authors.initials: DG
authors.lastname: Poplack
authors.forename: F M
authors.initials: FM
authors.lastname: Balis
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*; D009447:Neuroblastoma / Q000188:drug therapy; D018241:Neuroectodermal Tumors, Primitive, Peripheral / Q000188:drug therapy; D012516:Osteosarcoma / Q000188:drug therapy; D012208:Rhabdomyosarcoma / Q000188:drug therapy; D012512:Sarcoma, Ewing / Q000188:drug therapy; D012983:Soft Tissue Neoplasms / Q000188:drug therapy; D019772:Topotecan / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D019772:Topotecan