This study evaluated the efficacy and safety of topotecan, a topoisomerase I inhibitor, in patients with advanced squamous cell cancer of the head and neck. Topotecan was administered intravenously (over 30 min) daily for 5 days every 3 weeks at a starting dose of 1.5 mg/m2/day. Eligibility required no prior chemotherapy, measurable disease, and performance status of ≤2. Quality of life (QOL) assessment was performed at specified time points using the Spitzer QOL index and the symptom distress scale. Of 26 patients entered into the study, 23 and 22 patients were assessable for toxicity and response, respectively. One complete and two partial responses were observed, with response durations of D, 4, and 1.5 months, respectively. Six patients had stable disease, including one patient with a 45% tumor shrinkage. The median survival for all patients entered was 4 months. Neutropenia was the major dose-limiting side effect, with grade 4 toxicity observed in 42% of all cycles of treatment. Grade 3 anemia occurred in 16% of all cycles, and nine patients required blood transfusions. Nonhematologic toxicities were infrequent and mild to moderate. QOL assessment revealed no significant change of total scores between each assessment point. Topotecan is a well-tolerated new agent with similar single-agent activity to that of cisplatin, 5-fluorouracil, and methotrexate in advanced head and neck cancer. Further investigation of this agent with other chemotherapeutic drugs and with concurrent radiation therapy is appropriate.