Topotecan chemotherapy in patients with breast cancer and brain metastases: Results of a pilot study

Background: Symptomatic brain metastases occur in approximately 10-15% of p atients suffering from breast cancer and are linked to a clear deterioratio n of the patient's condition. Although radiotherapy is recommended as a pri mary therapy, the optimal management remains controversial. To evaluate the role of topotecan as a primary chemotherapy for brain metastases, we perfo rmed a pilot study in patients with metastatic breast cancer. Patients and Methods: 24 patients with newly diagnosed, bidimensionally measurable brain metastases received topotecan, 1.5 mg/m(2) day, 30-min infusion for 5 days every 3 weeks. A total of 93 courses of therapy were administered (range 1 -11, median 3 courses per patient). Prior radiotherapy was excluded. Most o f the patients had received prior adjuvant or palliative chemotherapy. Resu lts: 3/24 patients were withdrawn from the study for various reasons, 16/24 patients could be evaluated in terms of their response to therapy; 1 and 5 patients showed complete and partial response to therapy, respectively, an d 5 patients had a stable condition. The median time of survival was 6.25 m onths. Hematologic toxicity was the major side effect, nonhematologic side effects occurred rarely and were tolerable. Conclusions: Our results demons trate that primary chemotherapy with topotecan is an effective and well-tol erated treatment for patients with breast cancer and CNS metastases. Based on this pilot study, future clinical protocols should be developed includin g multimodal treatment strategies (i.e. radiotherapy).