title: Safety of topotecan monotherapy for relapsed small cell lung cancer patients with pre-existing interstitial lung disease.
abstract: OBJECTIVE
  To investigate the safety of intravenous topotecan monotherapy for relapsed small cell lung cancer (SCLC) patients with pre-existing interstitial lung disease (ILD).
  
  
  METHODS
  A total of 77 patients who received topotecan for the treatment of relapsed SCLC between April 2007 and April 2014 were reviewed. Patients with pre-existing ILD were identified using the pretreatment chest computed tomography. The safety of intravenous topotecan for SCLC patients with ILD was retrospectively examined, particularly focusing on topotecan-induced acute exacerbation of ILD (AE-ILD).
  
  
  RESULTS
  Twenty-three patients were identified as having pre-existing ILD [median age 74 (range 55-85) years; 21 men]. At the first topotecan administration, two-thirds (65.2%) had an Eastern Cooperative Oncology Group performance status 0 or 1. Topotecan was administered intravenously as second-line (n = 11) or later chemotherapy (n = 12). The median number of treatment cycles was two (range 1-7). The most common adverse events with grade 3 or 4 were neutropenia in 13 patients (56.5%) and thrombocytopenia in 10 patients (43.5%). Febrile neutropenia was observed in six patients (26.1%) and resulted in one death. AE-ILD occurred in five patients (21.7%; 95% confidence interval 4.9-38.5 %) 5-18 days after the last administration of topotecan and was fatal in three cases.
  
  
  CONCLUSIONS
  Intravenous topotecan monotherapy can be unsafe for relapsed SCLC patients with pre-existing ILD. Clinicians should be cautious regarding topotecan-induced AE-ILD as a lethal complication.
authors.affiliation: Department of Respiratory Medicine, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, 433-8558, Japan, yasuyasuyasu29@yahoo.co.jp.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Enomoto
authors.forename: Naoki
authors.initials: N
authors.lastname: Inui
authors.forename: Shiro
authors.initials: S
authors.lastname: Imokawa
authors.forename: Masato
authors.initials: M
authors.lastname: Karayama
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ozawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsui
authors.forename: Koshi
authors.initials: K
authors.lastname: Yokomura
authors.forename: Takafumi
authors.initials: T
authors.lastname: Suda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D055752:Small Cell Lung Carcinoma / Q000188:drug therapy* / Q000503:physiopathology; D059004:Topoisomerase I Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D019772:Topotecan / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D059004:Topoisomerase I Inhibitors; D019772:Topotecan