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

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 lymphoma Salvage therapy Topotecan Radiographic response Survival 

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

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