Efficacy of low‐dose topotecan in second‐line treatment for patients with epithelial ovarian carcinoma

Grønlund, Bo; Hansen, Heine H.; Høgdall, Claus; Engelholm, Svend A.

doi:10.1002/cncr.10838

Cited by 25 publications

(14 citation statements)

References 30 publications

(32 reference statements)

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“…Prospective studies have evaluated the potential role of lower-dose topotecan (1.0-1.25 mg/m 2 daily on days 1-5 of a 21-day course) in patients with heavily pretreated platinum-and paclitaxel-resistant or refractory ovarian cancer [18,[49][50][51][52]. The individual response rates for those studies are summarized in Table 4 [18, [49][50][51][52].…”

Section: Dose Reductionsmentioning

confidence: 99%

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Topotecan Dosing Guidelines in Ovarian Cancer: Reduction and Management of Hematologic Toxicity

Armstrong

2004

The Oncologist

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Topotecan dosing considerations and alternative dosing schedules to reduce and manage myelosuppression during the treatment of relapsed ovarian cancer were reviewed. The myelosuppression patterns from phase I, II, and III clinical trials were analyzed to evaluate the degree of hematologic toxicity and to determine risk factors predictive of myelosuppression. Additionally, recent publications of alternative topotecan doses and schedules were examined. Extent of prior therapy, prior platinum therapy (particularly carboplatin), advanced age, impaired renal function, and prior radiation therapy were identified as potential risk factors for greater hematologic toxicity after topotecan therapy. Reducing the starting topotecan dose to 1.0 or 1.25 mg/m 2 /day is recommended to reduce the incidence of severe myelosuppression in high-risk individuals receiving topotecan for 5 consecutive days. Hematopoietic growth factors, transfusion therapy, and schedule adjustments may also help manage myelosuppression. Alternative schedules of 3-day or weekly dosing appear to have less myelotoxicity and are currently under evaluation. The clinical aspects of topotecan-related myelosuppression and results from clinical trials indicate that the dose, and possibly the dosing schedule, of topotecan can be modified to reduce hematologic toxicity and improve tolerance without compromising efficacy. Prospective individualization of topotecan dosing may prevent or minimize dose-limiting myelosuppression and allow patients to achieve the maximum topotecan benefit by improving their ability to complete therapy with fewer treatment delays. Ongoing clinical trials evaluating alternative dosing schedules with superior hematologic tolerability may facilitate the inclusion of topotecan in combination regimens for patients with ovarian cancer. Proposed topotecan dosing guidelines to reduce and manage myelosuppression are outlined.

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Section: Dose Reductionsmentioning

confidence: 99%

“…The individual response rates for those studies are summarized in Table 4 [18, [49][50][51][52]. Among the 151 evaluable patients in five studies with platinum/paclitaxelresistant patients, 7%-22% achieved a response lasting from 3-10 months; stable disease (SD) was observed in 18%-60% of evaluable patients.…”

Section: Dose Reductionsmentioning

confidence: 99%

Topotecan Dosing Guidelines in Ovarian Cancer: Reduction and Management of Hematologic Toxicity

Armstrong

2004

The Oncologist

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“…A similar conclusion has been suggested by several authors regarding the importance of modifying the dose of liposomal doxorubicin that is delivered in platinum-resistant ovarian cancer [5][6][7] , as well as the use of topotecan for this identical clinical indication [8][9][10] .…”

mentioning

confidence: 59%

Use of Systemic Antineoplastic Drug Therapy after Regulatory Agency Approval

Markman¹

2007

Oncology

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“…Alternative schedules may provide higher tumor response rates and less myelosuppression compared to standard dose schedule. Several alternative dosing schedules like 21-day 24-hour continuous IV, a 3-day IV bolus, a weekly 72-hour continuous IV, and a weekly IV bolus regimen were explored in phase I and phase II clinical trials [26][27][28][29][30][31] . Although all of these trials have shown varied results, they can still be considered as promising.…”

Section: Discussionmentioning

confidence: 99%

Topotecan in Platinum-Resistant Epithelial Ovarian Cancer

Karabulut¹,

Sezgin²,

Terek

et al. 2005

Chemotherapy

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Background: Topotecan has been emerged as a new promising anticancer drug for patients with ovarian cancer. Methods: In this study, patients who were treated with topotecan were reviewed retrospectively. A total of 26 patients was included the study. All patients had received platinum-based regimens previously. Topotecan was administered a dose of 1.5 mg/m² intravenously 30 min daily for 5 days and repeated every 21 days. Results: The response rates were 30% by CA-125 level and 29% in clinic evaluation. Median duration of response was 8 (3–15) months, median progression-free interval was 12 (4–30) months and median overall survival was 15 (4–36) months. Grade 3–4 neutropenia occurred in 58% of the patients (38% of the courses) and trombocytopenia in 29% of the patients (12% of the courses). Nonhematological toxicities were mild. There was no drug-related death. Conclusion: Topotecan is considered as a reasonable option for treatment of patients with platinum refractory recurrent ovarian cancer.

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Efficacy of low‐dose topotecan in second‐line treatment for patients with epithelial ovarian carcinoma

Cited by 25 publications

References 30 publications

Topotecan Dosing Guidelines in Ovarian Cancer: Reduction and Management of Hematologic Toxicity

Topotecan Dosing Guidelines in Ovarian Cancer: Reduction and Management of Hematologic Toxicity

Use of Systemic Antineoplastic Drug Therapy after Regulatory Agency Approval

Topotecan in Platinum-Resistant Epithelial Ovarian Cancer

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