Abstract
Objective
The aim of this study was to define the maximum-tolerated dose (MTD) and observe the toxicity of escalating topotecan combined whole brain radiotherapy for brain metastasis in lung cancer.
Methods
Patients with brain metastasis of lung cancer received conventional fractionation radiotherapy, with 5 daily fractions of 2 Gy per week, the total radiation dose was 40 Gy, while the larger lesions were boosted to 50–60 Gy. The initial dose of topotecan was 1.0 mg/m2. Escalation dose was 0.25 mg/m2. Every cohort contained at least 3 patients. If no dose-limiting toxicity (DLT) was observed, the next dose level was opened for entry. These courses were repeated until DLT appeared. MTD was declared as one dose level below which DLT appeared.
Results
Eighteen patients were recruited. Two cases of grade 3 leucopenia/neutropenia was observed as DLT at the level of topotecan 2.0 mg/m2. MTD of topotecan was defined as 1.75 mg/m2. The major side effects were leucopenia/neutropenia, nausea and vomiting.
Conclusion
Topotecan combined with whole brain radiotherapy for brain metastasis in lung cancer is well tolerated. Maximum-tolerated dose of topotecan is 1.75 mg/m2, once a week of a total of four.
Similar content being viewed by others
References
Hsiung CY, Leung SW, Wang CJ, et al. The prognostic factor of lung cancer patients with brain metastases treated with radiotherapy. J Neuro Oncol, 1998, 36: 71–77.
Biswas G, Bhagwat R, Khurana R, et al. Brain metastasis—evidence based management. J Cancer Res Ther, 2006, 2: 5–13.
Hedde JP, Neuhaus T, Schüller H, et al. A phase I/II trial of topotecan and radiation therapy for brain metastases in patients with solid tumors. Int J Radiat Oncol Biol Phys, 2007, 68: 839–844.
Mirmiran A, McClay E, Spear MA. Phase I/II study of IV topotecan in combination with whole brain radiation for the treatment of brain metastases. Med Oncol, 2007, 24: 147–153.
Ratain MJ, Mick R, Sehilsky RL, et al. Statistical and ethical issues in the design and conduct of phase I and II clinical trials of new anticancer agents. J Natl Cancer Inst, 1993, 85: 1637–1643.
Kelly K, Bunn PA Jr. Is it time to reevaluate our approach to the treatment of brain metastases in patients with non-small cell lung cancer? Lung Cancer, 1998, 20: 85–91.
Liu MY, Zhou Y, Han Q, et al. Whole brain radiotherapy concomitant or sequential Vm26/DDP in treating small cell lung cancer patients with brain metastases. Chinese-German J Clin Oncol, 2010, 9: 17–21.
Zhou ZM, Wang LH, Lv JM, et al. Combined whole brain and radiotherapy with teniposide for brain metastasis of lung cancer: phase I clinical study. Chin J Radiat Oncol (Chinese), 2003, 12: 228–230.
Postmus PE, Smit EF, Haaxma-Reiche H, et al. Treatment of brain metastases of small cell lung cancer: compring teniposide and teniposide with whole-brain radiotherapy: a phase III study of the European Organization for the Research and treatment of lung cancer cooperative group. J Clin Oncol, 2000, 18: 3400–3408.
Wong ET. Berkenblit A. The role of topotecan in the treatment of brain metastases. Oncologist, 2004, 9: 68–79.
Zhou ZM, Wang LH, Lv JM, et al. A phase I clinical trial of topotecan plus radiotherapy in patients with local advanced stage of nonsmall cell lung cancer. Cancer Res Prev Treat (Chinese), 2005, 32: 116–118.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ge, X., Zhao, W., Ren, X. et al. A Phase I trial of dose escalation of topotecan combined with whole brain radiotherapy for brain metastasis in lung cancer. Chin. -Ger. J. Clin. Oncol. 11, 449–451 (2012). https://doi.org/10.1007/s10330-012-1008-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10330-012-1008-7