Dear OncoLink "Ask the Experts,"
I would appreciate it if you could send me any information that you might have to help me to decide about whether or not I should take Topotecan. I have AML and ALL acute leukemia. I am currently taking 5-AZA that seems to be helping me to some extent.
Bradley Somer, MD, Editorial Assistant for OncoLink, responds:
Let me preface this response by saying that your question is difficult to answer without complete access to your medical history. OncoLink has a policy of not rendering professional opinions via e-mail, as it is impossible to render an accurate diagnosis/treatment plan without examining a patient in person. This is true in general; however, it is even more complex in your situation given your diagnosis of leukemia with features of both AML and ALL. With this in mind, I hope that this provides more insight.
Topotecan (Hycamtin) is from the class of drugs known as the topoisomerase-I inhibitors and is derived from a Chinese plant- camptotheca acuminata. It has been shown to be an active drug in many malignancies, but recently has been shown to have activity against myelodysplastic syndrome (a pre-leukemia condition). There are also studies designed to determine dosage (but not effectiveness) that show that there is anti-leukemia activity with Topotecan- either alone or in combination with cytarabine, and with cytarabine and cytoxan. However, there are no definitive studies that compare it with the standard induction treatment.
Therefore, there are multiple studies that are being done throughout the country designed to definitively determine if there is a significant anti-leukemia effect to Topotecan. Currently, these studies are for patients who have failed more conventional therapy (refractory), or relapsed. So, Topotecan is not a first line treatment as there is very limited data on its activity against relapsed or refractory disease.
The decision to use Topotecan should also take into consideration how well you are responding to your current therapy, and what side effects you are encountering.
Please contact your oncologists for information regarding their decision to see how this information relates to you, and what clinical trials are available in your area.