combination chemotherapy in treating patients with advanced cancer

Conditions: Chronic Myeloproliferative Disorders; Leukemia; Lymphoma; Multiple Myeloma and Plasma Cell Neoplasm; Myelodysplastic Syndromes; Precancerous Condition; Unspecified Adult Solid Tumor, Protocol Specific

Summary: rationale: drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. combining more than one drug may kill more tumor cells. purpose: phase i trial to study the effectiveness of combining topotecan, fluorouracil, and leucovorin in treating patients who have advanced cancer.

objectives: i. evaluate the maximum tolerated dose (mtd) of continuous infusion topotecan in combination with fluorouracil for patients with advanced malignancy and establish a recommended phase ii dose based on the mtd. ii. evaluate the dose limiting toxicity of this combination in these patients. ii. obtain pharmacokinetic and pharmacodynamic data for topoisomerase-1 depletion in patients receiving this treatment. iv. identify any objective tumor responses arising from this treatment in these patients. outline: this is a dose-escalation study of topotecan in combination with fluorouracil. patients receive topotecan as a 24-hour continuous infusion on days 1-14 in combination with fluorouracil iv and leucovorin calcium iv on days 1-5; course repeats every 4 weeks. treatment continues in the absence of unacceptable toxicity or disease progression. in the absence of dose limiting toxicity (dlt) in the first cohort of 3 patients treated, subsequent cohorts each receive escalating doses on the same schedule. if dlt is observed in 2 of 3 patients or 2 of 6 patients at a given dose level, then dose escalation ceases and the next lower dose is declared the maximum tolerated dose. projected accrual: approximately 6-30 patients will be accrued for this study.

Eligibility criteria:
disease characteristics: histologically proven advanced malignancy patient characteristics: age: 18 and over performance status: ecog 0-2 life expectancy: at least 3 months hematopoietic: absolute neutrophil count greater than 1,500/mm3 platelet count greater than 100,000/mm3 hepatic: bilirubin less than 2.0 mg/dl sgot less than 3 times upper limit of normal (uln) (less than 5 times uln if due to hepatic metastases) ldh less than 3 times uln (less than 5 times uln if due to hepatic metastases) alkaline phosphatase less than 3 times uln (less than 5 times uln if due to hepatic metastases) renal: creatinine no greater than 1.5 mg/dl other: no active infection requiring systemic therapy within 1 week prior to entry no significant concurrent illness no history of bleeding disorder or clotting factor deficiency no dementia or altered mental status that would prohibit informed consent not pregnant or nursing effective contraception strongly advised for fertile women prior concurrent therapy: biologic therapy: no concurrent colony stimulating factors during topotecan infusion chemotherapy: at least 3 weeks since prior chemotherapy no more than 3 prior chemotherapy regimens endocrine therapy: not specified radiotherapy: at least 3 weeks since prior radiotherapy surgery: not specified

Keywords: stage iii adult hodgkin lymphoma stage iv adult hodgkin lymphoma monoclonal gammopathy of undetermined significance recurrent adult hodgkin lymphoma isolated plasmacytoma of bone extramedullary plasmacytoma refractory multiple myeloma waldenstrom macroglobulinemia stage iii multiple myeloma stage iv chronic lymphocytic leukemia recurrent adult acute myeloid leukemia recurrent adult acute lymphoblastic leukemia relapsing chronic myelogenous leukemia refractory chronic lymphocytic leukemia unspecified adult solid tumor, protocol specific chronic phase chronic myelogenous leukemia accelerated phase chronic myelogenous leukemia blastic phase chronic myelogenous leukemia meningeal chronic myelogenous leukemia untreated adult acute lymphoblastic leukemia untreated adult acute myeloid leukemia adult acute myeloid leukemia in remission adult acute lymphoblastic leukemia in remission polycythemia vera primary myelofibrosis essential thrombocythemia untreated hairy cell leukemia progressive hairy cell leukemia, initial treatment refractory hairy cell leukemia chronic myelomonocytic leukemia t-cell large granular lymphocyte leukemia acute undifferentiated leukemia stage iii grade 1 follicular lymphoma stage iii grade 2 follicular lymphoma stage iii grade 3 follicular lymphoma stage iii adult diffuse small cleaved cell lymphoma stage iii adult diffuse mixed cell lymphoma stage iii adult diffuse large cell lymphoma stage iii adult immunoblastic large cell lymphoma stage iii adult lymphoblastic lymphoma stage iii adult burkitt lymphoma stage iv grade 1 follicular lymphoma stage iv grade 2 follicular lymphoma stage iv grade 3 follicular lymphoma stage iv adult diffuse small cleaved cell lymphoma stage iv adult diffuse mixed cell lymphoma stage iv adult diffuse large cell lymphoma stage iv adult immunoblastic large cell lymphoma stage iv adult lymphoblastic lymphoma stage iv adult burkitt lymphoma recurrent grade 1 follicular lymphoma recurrent grade 2 follicular lymphoma recurrent grade 3 follicular lymphoma recurrent adult diffuse small cleaved cell lymphoma recurrent adult diffuse mixed cell lymphoma recurrent adult diffuse large cell lymphoma recurrent adult immunoblastic large cell lymphoma recurrent adult lymphoblastic lymphoma recurrent adult burkitt lymphoma stage iii adult t-cell leukemia/lymphoma stage iv adult t-cell leukemia/lymphoma recurrent adult t-cell leukemia/lymphoma secondary acute myeloid leukemia de novo myelodysplastic syndromes previously treated myelodysplastic syndromes secondary myelodysplastic syndromes prolymphocytic leukemia aids-related peripheral/systemic lymphoma aids-related primary cns lymphoma primary systemic amyloidosis stage iii mantle cell lymphoma stage iv mantle cell lymphoma recurrent mantle cell lymphoma angioimmunoblastic t-cell lymphoma anaplastic large cell lymphoma recurrent marginal zone lymphoma recurrent small lymphocytic lymphoma stage iii small lymphocytic lymphoma stage iii marginal zone lymphoma stage iv small lymphocytic lymphoma stage iv marginal zone lymphoma extranodal marginal zone b-cell lymphoma of mucosa-associated lymphoid tissue nodal marginal zone b-cell lymphoma splenic marginal zone lymphoma