• IV: Metastatic ovarian cancer that has not responded to previous chemotherapy. • Small cell lung cancer unresponsive to first line therapy. • PO: Relapsed small cell lung cancer in patients with a complete or partial prior response and who are at least 45 days from the end of first-line chemotherapy. • Stage IV-B persistent or recurrent cervical cancer not amenable to treatment with surgery or radiation (with cisplatin).
Adults:IV 0.75 mg/m2 daily infused over 30 min on days 1, 2, and 3, followed by IV cisplatin 50 mg/m2 infused on day 1 repeated every 21 days (a 21-day course). Prior to the first course of treatment, the patient must have a baseline absolute neutrophil count (ANC) of more than 1,500 cells/mm3 and a platelet count of more than 100,000 cells/mm3 .
Dosage Adjustment: In the event of severe febrile neutropenia (defined as less than 1,000 cells/mm3 with a temperature of 100.4°F), reduce the topotecan dose to 0.6 mg/m2 for subsequent courses. Similarly, reduce doses to 0.6 mg/m2 if the platelet count falls below 10,000 cells/mm3 . Alternatively, in the event of severe febrile neutropenia, filgrastim may be started on day 4 of each subsequent cycle; give the first filgrastim dose 24 h after the final topotecan dose. If febrile neutropenia occurs despite use of filgrastim, reduce the dose of topotecan to 0.45 mg/m2 for subsequent courses.
Ovarian or Small Cell Lung Cancer
Adults:IV 1.5 mg/m2 /day over 30 min daily for 5 consecutive days starting on day 1 of a 21-day cycle. Tumor response may be delayed; administer at least 4 cycles, provided the tumor is not progressing. Before giving each dose, the patient should have ANC greater than 1,500 cells/mm3 and a platelet count greater than 100,000 cells/mm3 .
Dosage Adjustment: If neutropenia develops (defined as ANC less than 1,500 cells/mm3 ), reduce the dose to 1.25 mg/m2 for subsequent doses. Alternately, a course of filgrastim may be started on day 6 of each subsequent cycle; give the first filgrastim dose 24 h after the final topotecan dose.
Relapsed Small Cell Lung Cancer
Adults:PO 2.3 mg/m2 once daily for 5 consecutive days repeated every 21 days. Round the calculated oral daily dose to the nearest 0.25 mg. Do not treat with subsequent courses of topotecan until neutrophils recover to more than 1,000 cell/mm3 , platelets recover to more than 100,000 cells/mm3 , and hemoglobin levels recover to at least 9 g/dL. Reduce the dose to 0.4 mg/m2 /day for subsequent courses in patients who experience severe neutropenia (neutrophils less than 500 cells/mm3 associated with fever of infection or lasting for 7 days or more) or neutropenia (neutrophils 500 to 1,000 cells/mm3 lasting beyond day 21 of the treatment course). The dose should be similarly reduced if the platelet count falls below 25,000 cells/mm3 .