Pharmacokinetics and pharmacodynamics of topotecan in patients with advanced cancer

Topotecan, a semisynthetic water-soluble analog of camptothecin, is the first topoisomerase I-directed drug to enter clinical trial in the United States in over 20 yr. In this study, 30-min infusions of topotecan were administered daily for 5 days every 3 weeks at doses ranging from 0.5 to 2.5 mg/m². Topotecan is reversibly hydrolyzed in a pH-dependent reaction in aqueous solutions to the ring-open hydroxy acid. The disposition of the closed ring lactone has been studied in 26 patients, and the disposition of both lactone and hydroxy acid has been studied in 12 patients. The clearance rate for topotecan lactone was 1220 ml/min/m², with a range of 300-4760 ml/min/m². The clearance rate for total topotecan (lactone and hydroxy acid) was 493 ml/min/m², with a range of 163-815 ml/min/m². A model for the disposition of lactone and hydroxy acid incorporating both reversible hydrolysis and elimination was developed. We have shown that topotecan is partially hydrolyzed prior to administration in parenteral solutions, and that clearance of the parent compound proceeds in vivo by conversion to hydroxy acid and elimination. Renal clearance accounted for 30 ± 18% of drug elimination in patients. The relationship between topotecan dose and myelotoxicity is well fit by a sigmoidal E(max) model, as is the relationship between total topotecan area under the concentration-time curve and myelotoxicity. The disposition of topotecan was also studied in mice. The clearance rate for total topotecan in mice was 330 ml/min/m² after administration of topotecan lactone. Administration of topotecan as the ring- opened hydroxy acid sodium salt in mice bearing iv L1210 leukemia resulted in identical efficacy, but the hydroxy acid was one-third as potent as the lactone. This could be explained in part by the higher clearance rate for total topotecan after administration as hydroxy acid (620 ml/min/m²).