Oral topotecan as single-agent second-line chemotherapy in patients with advanced ovarian cancer

Clarke-Pearson, D.L., Van Le, L., Iveson, T., Whitney, C.W., Hanjani, P., Kristensen, G., Malfetano, J.H., Beckman, R.A., Ross, G.A., Lane, S.R., DeWitte, M.H. and Fields, S.Z. (2001) Oral topotecan as single-agent second-line chemotherapy in patients with advanced ovarian cancer. Journal of Clinical Oncology, 19 (19), 3967-3975.

Abstract

Purpose: To evaluate oral topotecan as single-agent, second-line therapy in patients with ovarian cancer previously treated with a platinum-based regimen.
Patients and Methods: Patients (N = 116) received oral topotecan 2.3 mg/m2 daily for 5 days every 21 days. Eligibility criteria included histologic diagnosis of International Federation of Gynecology and Obstetrics stage III or IV epithelial ovarian cancer, bidimensionally measurable disease, prior platinum-containing chemotherapy, age >= 18 years, performance status <= 2, and life expectancy >= 12 weeks.
Results: Overall response rate was 21.6% (25 of 116 patients). Median duration of response was 25.0 weeks; median time to response was 8.4 weeks. Median time to progression was 14.1 weeks; median survival was 62.2 weeks. Grade 4 neutropenia was experienced by 50.4% of patients in 13.4% of courses administered. Grade 4 thrombocytopenia was experienced by 22.1% of patients in 5.1% of courses. Grade 3 or 4 anemia was experienced by 29.2% of patients in 8.5% of courses. Most frequent nonhematologic toxicities were predominantly (> 90%) grade 1 or 2 and included nausea, alopecia, diarrhea, and vomiting.
Conclusion: Second-line oral topotecan administered at 2.3 mg/m2 for 5 days every 21 days demonstrated activity in patients with progressive or recurrent ovarian cancer after first-line platinum-based chemotherapy. This activity was comparable to that seen in previous studies with intravenous topotecan. Grade 4 neutropenia was less frequent with oral topotecan than previously reported for intravenous topotecan. Oral topotecan is an active, tolerable, and convenient formulation of an established agent for the second-line treatment of advanced epithelial ovarian cancer and may also facilitate exploring prolonged treatment schedules.

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Contributors

Author: T. Iveson

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