RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing
so they stop growing or die. Colony-stimulating factors such as sargramostim may increase
the number of immune cells found in bone marrow or peripheral blood and may help a person's
immune system recover from the side effects of chemotherapy.
PURPOSE: Phase I/II trial to study the effectiveness of topotecan plus sargramostim in
treating patients who have advanced cancer.
OBJECTIVES: I. Identify a priming schedule of sargramostim (GM-CSF) that reduces the
percentage of progenitor cells in cycle at the time of chemotherapy administration in
patients with advanced malignancies. II. Determine the maximum tolerated dose and toxic
effects of topotecan when administered with sargramostim in these patients. III. Conduct a
preliminary assessment of the activity of this topotecan regimen in these patients.
OUTLINE: This is a dose escalation study of topotecan. Patients receive priming with
sargramostim (GM-CSF) on days -4 through -2. On day 0, topotecan IV is administered over 30
minutes. Cohorts of 6 patients receive escalating doses of topotecan. The maximum tolerated
dose (MTD) is defined as the dose preceding that at which 2 of 6 patients experience
dose-limiting toxicity (DLT). Sargramostim resumes on day 1 following topotecan, and
continues for 5 days or until sufficient hematologic recovery. The next course of topotecan
is given 48 hours later. Treatment repeats every 6 weeks for 4 courses. Patients are
followed every 3 months for the first year, then every 6 months thereafter.
PROJECTED ACCRUAL: 15-25 patients will be accrued for the duration of 18 months.
DISEASE CHARACTERISTICS: Histologically proven malignancy for which no alternative
PATIENT CHARACTERISTICS: Age: 18 and over Performance status: ECOG 0-2 Life expectancy: At
least 3 months Hematopoietic: Platelet count at least 100,000/mm3 Absolute neutrophil
count at least 1500/mm3 Hepatic: Total bilirubin no greater than 2.0 mg/dL Renal:
Creatinine clearance at least 50 mL/min Other: No active infections HIV negative No other
concurrent medical condition
PRIOR CONCURRENT THERAPY: Biologic therapy: Not specified Chemotherapy: At least 3 weeks
since prior chemotherapy (6 weeks for nitrosoureas or mitomycin) Endocrine therapy: Not
specified Radiotherapy: No prior wide field radiotherapy No prior radiotherapy to greater
than 20% of bone marrow Surgery: Recovered from prior surgery