Weekly topotecan in the management of lung cancer

Chemotherapy agents require a range of administration schedules, including 3-weekly, 4-weekly and daily administration. Some agents, for example gemcitabine and vinorelbine, have been developed for use in a weekly regimen. The possibility of administering other agents using a weekly schedule is being investigated. Weekly schedules offer practical benefits in terms of convenience to patients and allow drugs to be combined more easily. In addition, toxicity may be reduced. The standard 5-day schedule of topotecan has demonstrated effectiveness and patient benefits. Topotecan at this dose is generally well tolerated, with dose-limiting myelosuppression. Preclinical data supported intermittent dosing with topotecan and clinical studies with weekly dosing in ovarian cancer have indicated reduced myelosuppression compared with the 5-day regimen. Several studies in non-small cell lung cancer investigated topotecan combined with cisplatin or gemcitabine and confirmed these findings. However, further studies are needed to confirm that efficacy of topotecan (response and survival) is maintained with the altered regimen.