Journal of Neuro-Oncology

, Volume 86, Issue 2, pp 211–215

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

  • Alfredo D. Voloschin
  • Rebecca Betensky
  • Patrick Y. Wen
  • Fred Hochberg
  • Tracy Batchelor
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
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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

Authors and Affiliations

  • Alfredo D. Voloschin
    • 1
  • Rebecca Betensky
    • 2
  • Patrick Y. Wen
    • 3
    • 4
    • 5
  • Fred Hochberg
    • 5
    • 6
  • Tracy Batchelor
    • 5
    • 6
    • 7
  1. 1.Department of NeurosurgeryMedical College of GeorgiaAugustaUSA
  2. 2.Department of BiostatisticsHarvard School of Public HealthBostonUSA
  3. 3.Department of NeurologyBrigham and Women’s HospitalBostonUSA
  4. 4.Center For Neuro-OncologyDana Farber/Brigham and Women’s Cancer CenterBostonUSA
  5. 5.Harvard Medical SchoolBostonUSA
  6. 6.Department of Neurology, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Yawkey 9EMassachusetts General HospitalBostonUSA
  7. 7.Department of Radiation Oncology and NeurologyMassachusetts General HospitalBostonUSA