Topotecan given as 5 daily infusions is associated with significant myelosuppression and poor patient acceptance. Non hematologic toxicities are usually mild and not dose-limiting. Although the 5 day schedule can be inconvenient, the relative lack of acute toxicity still makes topotecan a good candidate for out-patient chemotherapy in selected patients. Although the impact of bone marrow suppression can be minimized by the use of cytokines, these 5 day regimens have required substantial dose reduction.