Journal of Clinical Oncology, Vol 16, 589-592, Copyright © 1998 by American Society of Clinical Oncology
Evaluation of topotecan in resistant and relapsing multiple myeloma: a Southwest Oncology Group study
EH Kraut, JJ Crowley, JL Wade, LR Laufman, M Alsina, SA Taylor and SE Salmon
Ohio State University, Columbus, USA.
PURPOSE: Topotecan is a topoisomerase I inhibitor with antitumor activity
against hematologic and solid tumor malignancies. We evaluated its activity
in refractory and relapsing multiple myeloma patients who had received one
prior chemotherapeutic regimen. PATIENTS AND METHODS: Toptecan 1.25 mg/m2/d
was administered as a 30-minute infusion for 5 days repeated every 3 weeks.
Granulocyte colony-stimulating factor (G- CSF) 5 microg/kg/d subcutaneously
was administered after the first course of treatment if neutropenia was
dose-limiting. RESULTS: Forty- six patients entered the study, with 43
patients eligible. The major toxicity was granulocytopenia with grade 3 or
better occurring in 40 of 43 patients treated; 21 of 43 patients developed
grade 3 or greater thrombocytopenia. Other significant toxicity included
mild nausea in 23 patients and mild vomiting in 13 patients. The overall
response rate (partial response or better) was 16% (95% confidence
interval, 7% to 31%), with responses occurring in both relapsed and
refractory patients. Responses have lasted 70 to 477+ days, with a median
progression-free survival duration of 13 months and median survival time of
28 months. CONCLUSION: Topotecan has activity in refractory and relapsing
multiple myeloma. Future investigation of topotecan in multiple myeloma
including combination therapy and the study of other topoismerase I
inhibitors is warranted.
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