Evaluation of topotecan and etoposide for non-hodgkin lymphoma

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Abstract
Topotecan, a topoisomerase I inhibitor, acts by stabilizing the topoisomerase DNA cleavage complex. Etoposide, a topoisomerase II inhibitor, mediates antitumor activity by stabilizing cleavage complex formed between topoisomerase II and DNA. These two agents have therapeutic activity in non-Hodgkin lymphoma. The authors report Phase I data of topotecan and etoposide combination for patients with recurrent or refractory non-Hodgkin lymphoma and correlation of topoisomerase–DNA complex formation to clinical response. Twenty-two patients with recurrent or refractory aggressive non-Hodgkin lymphoma were treated at four dose levels of topotecan (1 mg/m2/day to 2.5 mg/m2/day). Topotecan was given at a 30-minute infusion daily with etoposide 150 mg/m2/day, both for 5 days. Topoisomerase–DNA covalent complex formation was measured using in vivo link assay, whereas topoisomerase I, IIα, and IIβ in RNA expression levels were determined by reverse transcription–polymerase chain reaction in blood samples. The relation of these levels to clinical response was studied. The maximum tolerated dose of topotecan was 2.0 mg/m2/day for 5 days. Oropharyngeal mucositis was dose-limiting. Of 21 examinable patients, 3 patients achieved complete remission, and 5 patients achieved partial remission. Of six untreated patients who experienced a recurrence, three had complete remission, and the other three had partial remission. Drug-induced topoisomerase–DNA complex formation was observed throughout the treatment in blood samples of all the patients who responded. However, only 4 of 13 patients, who did not respond, formed covalent complex at all time points. This was statistically significant (P = 0.024). In all patients, expression levels of topoisomerase I and IIβ mRNA remained similar to pretreatment levels, whereas topoisomerase IIα mRNA levels decreased dramatically by the third day. The recommended Phase II dose of topotecan with etoposide of 150 mg/m2/day for 5 days was 2.0 mg/m2/day for 5 days. Topoisomerase–DNA complex formation correlated with response to treatment. Cancer 2001;91:463–71. © 2001 American Cancer Society.

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