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Phase I Study of Topotecan Plus Cranial Radiation for Glioblastoma Multiforme: Results of Radiation Therapy Oncology Group Trial 9507

From the Departments of Radiation Oncology and Medical Oncology, London Regional Cancer Center, and Departments of Oncology and Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada; Radiation Oncology Headquarters, Philadelphia, PA; Dartmouth-Hitchcock Medical Center, Department of Radiation Oncology, Lahey-Hitchcock Medical Center, Lebanon, NH; and Department of Radiation Oncology, TJ University Hospital Bodine Center for Cancer Treatment, Philadelphia, PA.

Address reprint requests to Barbara Fisher, MD, London Regional Cancer Center, 790 Commissioners Road East, London, Ontario, Canada N6A 4L6.

PURPOSE: A phase I trial was conducted by the Radiation Therapy Oncology Group (RTOG) to determine the maximum-tolerated dose of topotecan that could be safely combined with standard cranial radiation for glioblastoma multiforme. A secondary objective was to document the acute and late toxicities of this combination of chemotherapy and radiation.

PATIENTS AND METHODS: Forty-seven patients with histologically confirmed glioblastoma multiforme were entered onto this phase I trial. Three cycles of topotecan were administered at 21-day intervals commencing at day 1 of cranial radiotherapy (60 Gy/30 fractions). Each cycle consisted of daily 30-minute intravenous (IV) infusions for 5 days. The dose of topotecan was escalated in three-dose increments from 0.5 mg/m²/d to 1.0 mg/m²/d to 1.5 mg/m²/d in different patient groups.

RESULTS: The majority of patients were over age 50. Three dose levels of topotecan were tested. Fifteen patients accrued to level 1 (topotecan dose 0.5 mg/m²/d). No grade 4 toxicities were seen. Sixteen patients accrued to level 2 (topotecan dose 1.0 mg/m²/d), five of whom had brief episodes of grade 4 neutropenia. Seventeen patients accrued to level 3 (1.5 mg/m²/d). Six of these patients had brief episodes of grade 4 neutropenia and four developed grade 3 thrombocytopenia. No serious nonhematologic or late toxicities were seen. Median survival for all patients was 9.7 months. There was no apparent difference in survival by topotecan dose schedule.

CONCLUSION: Toxicity was acceptable at an IV topotecan dose of 1.5 mg/m²/d administered daily for 5 days every 21 days for three cycles. A phase II trial has been performed using this dose of topotecan.

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