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Weekly topotecan is well tolerated in the third-line or later treatment of patients with epithelial ovarian carcinoma (EOC) and may prolong time to disease progression.

5067 Background: To determine the tolerability and treatment benefit of weekly topotecan in pts with recurrent EOC.


METHODS
IRB approval was received for a retrospective review of pt records. Eligible pts had received ≥ 2 prior cytotoxic chemotherapy regimens before receiving weekly topotecan for EOC. Follow-up data were obtained by review of medical records. All pts who received topotecan were evaluable for toxicity, and pts who completed ≥ 4 weeks of topotecan therapy were considered evaluable for tumor response.


RESULTS
Thirty eligible pts were identified; 24 (80%) had stage ≥ 3 EOC, 20 had received 2 prior chemotherapy regimens, 4 had received 3, and 6 had received ≥ 4. All pts had received paclitaxel/carboplatin as first- or second-line chemotherapy, and 22 (73%) were platinum sensitive. All pts had measurable disease at baseline, with a median CA-125 of 421 U/mL (range, 13 - 7,200). All pts started at topotecan 4 mg/m2. A total of 464 weeks (116 cycles) of topotecan were administered. No grade 3 or 4 nonhematologic toxicity occurred; the only grade 2 event was neuropathy in 2 pts. Hematologic toxicity was acceptable, with no grade 4 toxicity or neutropenic fevers. Grade 3 toxicities included anemia in 8 (27%) pts, neutropenia in 5 (17%) pts, and thrombocytopenia in 1 (3%) pt. Hematologic toxicity was managed by dose reduction to 3.5 mg/m2 in 5 (17%) pts. Twenty-eight pts who received a median of 11 weeks (range, 4 - 77) of therapy were evaluable for response. Three (11%) pts had a partial response and 11 (39%) had stable disease. In these 15 pts, mean time to progression was 6 months (range, 1 - 17). Treatment resulted in CA-125 decreases (median decline, 41%) in 18 (64%) pts. Of note, 2 pts had stable disease of 60 and 77 weeks' duration.


CONCLUSIONS
Heavily pretreated pts with EOC are especially susceptible to hematologic toxicities associated with the standard topotecan regimen. However, weekly treatment with topotecan 4 mg/m2 was well tolerated in heavily pretreated pts and showed favorable activity in this retrospective analysis. Further investigations in the third-line or later settings are recommended. No significant financial relationships to disclose.