84 Phase II study of topotecan in refractory and sensitive small cell lung cancer (SCLC)

A phase II study of topotecan administered five times daily in patients with advanced gastric cancer

OBJECTIVE

Topotecan (Tpt), a semisynthetic analogue of camptothecin (Cpt), has shown excellent preclinical activity in a number of solid tumors. Cpt, the parent compound, has preclinical activity against several gastrointestinal tumors, including a gastric adenocarcinoma xenograft. A phase-II clinical trial was conducted to assess the activity to Tpt in patients with advanced gastric cancer.

MATERIALS AND METHODS

15 patients with advanced, incurable gastric adenocarcinomas were treated. Tpt 1.5 (mg/m2/day) was administered intravenously as a 30-min infusion daily for 5 consecutive days. Treatments were repeated on a 21-days cycle.

RESULTS

No major objective responses were observed in 13 evaluable patients (response rate = 0%; 95% confidence interval = 0-22%). The major dose-limiting toxicity in this trial was myelosuppression, which was severe in this patient population.

CONCLUSIONS

Tpt at the dose and schedule studies does not possess substantial antitumor activity in patient with gastric cancer, and the toxicities were formidable. We do not advocate further development of this drug in the treatment of gastric cancer. Tpt has shown more promising activity and tolerability in other patient populations, and these areas deserve further exploration.

Moving the Frontiers of Cancer Chemotherapy for Solid Tumors by Changing the Scope of Drug Development

Our increasing knowledge on the pathogenetic mechanisms involved in the growth of cancer cells and on the molecular basis of cancer has influenced the development of anticancer agents. The realization that new targets should be evaluated for anti-cancer drug treatment has a.o. led to the introduction of the taxoids and topoisomerase I inhibitors. Attacking the known targets in a more sophisticated way led to the development of drugs with increased target specificity like Tomudex and Gemcitabine. Finally, using old drugs more efficiently by using pharmacokinetic and pharmacodynamic ananlysis hold a promise for the near future.