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Sarcoma
Volume 2012, Article ID 749067, 4 pages
http://dx.doi.org/10.1155/2012/749067
Research Article

Topotecan and Cyclophosphamide in Adults with Relapsed Sarcoma

1Department of Internal Medicine, University of Toronto, Toronto, Canada
2Department of Medical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Canada
3University Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Canada
4Division of General Surgery, Mount Sinai Hospital, University of Toronto, Canada
5Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Canada

Received 1 May 2012; Accepted 1 June 2012

Academic Editor: Luca Sangiorgi

Copyright © 2012 P. Blanchette et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. The combination of topotecan and cyclophosphamide (TC) has activity in pediatric patients with recurrent sarcoma, especially Ewing’s sarcoma (EWS). We sought to determine the toxicity of and response to TC in adults with recurrent sarcoma. Patients and Methods. Adults treated with TC from 2005 to 2010 were reviewed who received T = topotecan at 0.75 mg/m2/day (days 1–5) and C = cyclophosphamide at 250 mg/m2/day (days 1–5) every 21 days. Results. Fifteen patients, median age 31 years (range 17.5–56) had nonpleomorphic rhabdomyosarcoma (RMS, ), EWS, , synovial sarcoma (SS, ) leiomyosarcoma (LMS, ), and desmoplastic small round cell tumour (DSRCT, ). Median time to progression was 2.5 months (range 1.6–13.0). Partial responses were seen in 2/6 RMS and 1/2 SS. Stable disease was seen in 2/5 EWS, 1/2 SS and 1 DSRCT. The most common reason for stopping treatment was progressive disease 12/15, (80%). Hematologic toxicity was common; 7 (47%) patients required blood product transfusion, 5 (33%) patients had fever/neutropenia. At median follow-up time of 7.7 months, all but 1 patient had died of disease. Conclusion: TC combination is tolerable but has only modest activity in adults with recurrent sarcoma. Other regimens deserve exploration for this high-risk group of patients