Conflict of Interest: Nothing to declare.
A phase-1 pharmacokinetic optimal dosing study of intraventricular topotecan for children with neoplastic meningitis: A pediatric brain tumor consortium study†
Article first published online: 21 SEP 2012
Copyright © 2012 Wiley Periodicals, Inc.
Pediatric Blood & Cancer
Volume 60, Issue 4, pages 627–632, April 2013
How to Cite
Blaney, S. M., Tagen, M., Onar-Thomas, A., Berg, S. L., Gururangan, S., Scorsone, K., Su, J., Goldman, S., Kieran, M. W., Kun, L., Boyett, J. and Stewart, C. (2013), A phase-1 pharmacokinetic optimal dosing study of intraventricular topotecan for children with neoplastic meningitis: A pediatric brain tumor consortium study. Pediatr. Blood Cancer, 60: 627–632. doi: 10.1002/pbc.24309
- Issue published online: 13 FEB 2013
- Article first published online: 21 SEP 2012
- Manuscript Accepted: 9 AUG 2012
- Manuscript Received: 22 MAY 2012
- 5 U01. Grant Number: CA81457
- NCRR. Grant Number: M01 RR00188
- neoplastic meningitis;
We performed a phase-1 pharmacokinetic optimal dosing study of intraventricular topotecan (IT), administered daily 5×, to determine whether, the maximum tolerated dose of IT topotecan was also the pharmacokinetic optimal dose.
Patients and Methods
Patients received topotecan administered through an intraventricular access device (0.1 or 0.2 mg/dose), daily × 5 every other week 2× (Induction); every 3 weeks × 2 (Consolidation); then every 4 weeks for up to 11 courses (Maintenance). Ventricular CSF pharmacokinetic studies were performed on day 1, week 1 of induction, and in a subset of patients after a single intralumbar topotecan dose on day 1, week 3.
Nineteen patients were enrolled. All were evaluable for toxicity and 18 were assessable for pharmacokinetics. Arachnoiditis requiring corticosteroid therapy occurred in or one of three patients at the 0.1 mg dose level and two of the initial three patients enrolled at the 0.2 mg dose level. All subsequent patients were therefore treated with concomitant dexamethasone. Pharmacokinetic evaluation after accrual of the first seven patients revealed that a topotecan lactone concentration >1 ng/ml for 8 hours was attained in all patients and thus, further dose escalation was not pursued. Results of simulation studies showed that at the dose levels evaluated, >99.9% of patients are expected to achieve CSF topotecan lactone concentrations >1 ng/ml for at least 8 hours.
Intraventricular topotecan, 0.2 mg, administered daily for 5 days with concomitant dexamethasone is well tolerated and was defined to be the pharmacokinetic optimal dose in this trial. Pediatr Blood Cancer 2013; 60: 627–632. © 2012 Wiley Periodicals, Inc.