Intrathecal topotecan in adult patients with neoplastic meningitis.
OBJECTIVE
The efficacy and safety of intrathecal topotecan were assessed in patients with neoplastic meningitis (NM) by retrospective chart review.


CONCLUSIONS
Fourteen patients (median age, 57 years) with NM were treated with the standard of care (i.e., regional or systemic chemotherapy or irradiation or both) plus intrathecal topotecan between January 2004 and September 2005. Three patients developed NM in the setting of systemic cancer; 11 patients had primary central nervous system (CNS) malignancies. All patients received 0.4 mg of topotecan intrathecally two times per week. The efficacy of intrathecal topotecan was assessed on the basis of the number of doses to cerebrospinal fluid (CSF) cytologic clearing--defined as the disappearance of malignant cells from a previously positive CSF cytology. Safety was evaluated by chart documentation of adverse events that might have been associated with topotecan given intrathecally. Of the 11 patients with primary CNS tumors, 6 patients achieved CSF clearing after the first dose of intrathecal topotecan, 2 patients after the second dose, and 1 patient after the fifth dose. For the 3 patients with secondary CSF tumors, 1 patient achieved CSF clearing after the third dose and 2 patients did not reach the primary endpoint. Overall, 6 of the 14 patients achieved CSF clearing after the first dose of intrathecal topotecan; in 10 of the 14 patients, CSF clearing of malignant cells was observed at some point during treatment. Toxicity was modest. The most common adverse effect reported was fatigue.


CONCLUSIONS
Intrathecal topotecan appeared to be effective and safe in adult patients with NM.
Gammon
David C
DC
Department of Pharmacy, UMass Memorial Medical Center, University Campus, Worcester, MA 01655, USA. gammond@ummhc.org
Bhatt
Mansi S
MS
Tran
Lan
L
Van Horn
Alexis
A
Benvenuti
Matthew
M
Glantz
Michael J
MJ
D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008485:Medical Audit; D008577:Meningeal Neoplasms / Q000188:drug therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D019772:Topotecan / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D019772:Topotecan