Journal of Neuro-Oncology

, Volume 86, Issue 2, pp 211–215

Topotecan as salvage therapy for relapsed or refractory primary central nervous system lymphoma

Authors

  • Alfredo D. Voloschin
    • Department of NeurosurgeryMedical College of Georgia
  • Rebecca Betensky
    • Department of BiostatisticsHarvard School of Public Health
  • Patrick Y. Wen
    • Department of NeurologyBrigham and Women’s Hospital
    • Center For Neuro-OncologyDana Farber/Brigham and Women’s Cancer Center
    • Harvard Medical School
  • Fred Hochberg
    • Harvard Medical School
    • Department of Neurology, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Yawkey 9EMassachusetts General Hospital
    • Harvard Medical School
    • Department of Neurology, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Yawkey 9EMassachusetts General Hospital
    • Department of Radiation Oncology and NeurologyMassachusetts General Hospital
Clinical-patient studies

DOI: 10.1007/s11060-007-9464-6

Cite this article as:
Voloschin, A.D., Betensky, R., Wen, P.Y. et al. J Neurooncol (2008) 86: 211. doi:10.1007/s11060-007-9464-6

Abstract

Treatment for patients with refractory or relapsed primary CNS lymphoma (PCNSL) remains unsatisfactory. Topotecan is an intravenous topoisomerase I inhibitor with good CSF penetration and documented efficacy in patients with relapsed systemic non-Hodgkin’s lymphoma. In this study 15 patients with refractory or relapsed PCNSL were treated with intravenous topotecan (1.5 mg/m2) for five consecutive days during each 21-day cycle. All 15 patients had measurable, contrast-enhancing tumor on cranial MRI at the time of relapse. Three (20%) patients achieved a complete response after one, three and four cycles, respectively, while three (20%) patients achieved a partial response after two cycles each, for a total response proportion of 40%. Three patients had stable disease at the end of topotecan treatment. Six patients (40%) had progressive disease during treatment. Median overall survival was 981 days (95% CI: 275, NA) and median progression free survival was 60 days (95% CI: 46, 945). Three out of 15 patients had grade 3 thrombocytopenia. Six out of 15 patients had grade 3 neutropenia, while 5/15 patients had grade 4 neutropenia, and 13/15 patients received g-CSF at some point during treatment. There were no deaths directly related to treatment toxicity. Our study shows that topotecan, as a salvage therapy in patients with relapsed or refractory PCNSL, is associated with an overall response proportion of 40% and should be considered in patients who have failed prior methotrexate-based chemotherapy and/or whole brain irradiation. However, progression is frequent and early and most patients required growth factor support due to myelotoxicity.

Keywords

Primary CNS lymphomaSalvage therapyTopotecanRadiographic responseSurvival

Copyright information

© Springer Science+Business Media, LLC 2007