Front-line topotecan (T) with or without whole-brain radiation (WBRT) followed by alternating T and platinum/etoposide (PE) for patients (Pts) with small cell lung cancer (SCLC) and brain metastases (mets).

e18100 Background: T is active in relapsed SCLC and reaches the CNS. Eligible pts with SCLC and brain mets received 2 cycles of T, then alternating PE/T. WBRT was given concurrently for symptomatic brain mets. Methods: Prior PE was allowed, including one PE cycle at entry. Pts received T 1.5 mg/m2/d iv D 1-5 × 2 21D cycles. For history of hematologic compromise; T = 1.2 mg/m2/d D #1-5. Responding pts alternated PE (cisplatin 60 mg/m2 or carboplatin AUC 5 D #1 + E 120 mg/m2 D #1-3, 21-D cycles) with T for up to 8 cycles. Symptomatic brain mets received WBRT with 50% dose reduction cycle 1 T. Primary endpoint was response (OR), with planned 2-stage design (19 pts first; 39 pts second assessment). Results: 15 pts were treated (1999-2004) before the study was closed due to slow accrual. Pt characteristics: Male/female (no.) = 10/5; median age = 66; ECOG PS 0/1/2 (no.) = 4/7/4. 6 received prior PE. Median cycles = 5 (1-8). 4 pts received concurrent WBRT. SAEs occurred in 12 pts. Hematologic (Gr 3/4): anemia (2...