Topotecan for Recurrent Ovarian Cancer: A Systemic Review_Chinese Journal of Evidence-Based Medicine

Authors：

1. Department of Gynecology, the Second Hospital Affiliated to West China University of Medical Sciences, Sichuan University, Chengdu 610041, China 2. Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Recurrent ovarian cancer (ROC); Topotecan (TPT); Pegylated liposomal doxorubicin (PLD); Paclitaxel (TAX)

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Objective 　To assess the clinical efficacy, safety and cost-effectiveness of topotecan for recurrent epithelial ovarian cancer.
Methods 　We searched MEDLINE (1966 to 2005), EMbase (1989 to 2004), CancerLit (1996 to 2003), CBMdisc (1978 to 2005), CNKI (1994 to 2005), The Cochrane Library (Issue 3, 2005), The National Research Register, and the Health Technology Assessment Database (HTA). Relevant journals were also handsearched. The search was conducted on December 31, 2005. Randomize controlled trials (RCTs) comparing topotecan versus other agents for recurrent epithelial ovarian cancer were included. The quality of the eligible trials was assessed by two reviewers independently. Meta-analysis was performed.
Results 　Four RCTs met the inclusion criteria, and the methodological quality was either level A or B. When used as second-line chemotherapy for recurrent ovarian cancer, there was no significant difference in remission rate between topotecan and paclitaxel or pegylated liposomal doxorubicin (PLD). The clinical benefit rate of topotecan was higher than that of paclitaxel or PLD. Myelosuppression was more frequent in patients in the topotecan group than those in the PLD or paclitaxel group, but it was not severe. As to cost-effectiveness analysis, topotecan was better than PLD.
Conclusions 　The standard regimen of topotecan (intravenous 1.5 mg/m2/d for 5 consecutive days) is recommended for use in platinum-resistant and refractory ovarian cancer.

Citation： PEI Haiying,FANG Fang,WU Taixiang. Topotecan for Recurrent Ovarian Cancer: A Systemic Review. Chinese Journal of Evidence-Based Medicine, 2006, 06(10): 733-742. doi: Copy

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2.	Latorre A, De Lena M, Catino A, et al. Epithelial ovarian cancer-second and third line chemotherapy (review). Int J Oncol, 2002; 21(6): 179–186.
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9.	Rustin GJS, Nelstrop ARE, McClean P, et al. Defining response of ovarian carcinoma to initial chemotherapy according to serum CA-125. Clin Oncol, 1996; 14(5): 1545–1551.
10.	Rustin GJS, Nelstrop ARE, Crawford M, et al. Phase II trial of oral altretamine for relapsed ovarian carcinoma: Evaluation of defining response by serum CA-125. Clin Oncol, 1997; 15(1): 172–176.
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12.	Gordon-AN, Fleagle-JT, Guthrie-D, et al. Recurrent Epithelial Ovarian Carcinoma: A Randomized Phase III Study of Pegylated Liposomal Doxorubicin Versus Topotecan. Clinical Oncology, 2001; 19(14): 3312–3322.
13.	Smith DH, Adams JR, Johnston SR, et al. A comparative economic analysis of pegylated liposomal doxorubicin versus topotecan in ovarian cancer in the USA and the UK. Ann Oncol, 2002; 13(10):.
14.	Cohen J: A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 1960; 20(42): 37–46.
15.	Moher D, Pham B, Jones A, et al. Does quality of reports of randomized trials affectestimates of intervention efficacy reported in meta-analyses. Lancet, 1998; 352(9128): 609–613.
16.	Gordon AN,Tonda M,Sun S, et al. Doxil Study 30-49 Investigators. Long-term survival advantage for women treated with pegylated liposomal doxorubicin compared with topotecan in a phase 3 randomized study of recurrent and refractory epithelial ovarian cancer. Gynecol Oncol, 2004; 95(1): 1–8.
17.	Capri S, Cattaneo G. Cost-minimization analysis of pegylated liposomal doxorubicin versus topotecan for the treatment of ovarian cancer in Italy. Clin Ther, 2003; 25(6): 1826–1845.
18.	Ojeda B, de Sande LM, Casado A, et al. Cost-minisation analysis of pegylated liposomal doxorubicin hydrochloride versus topotecan in the treatment of patients with recurrent epithelial ovarian cancer in Spain. Br. J Cancer, 2003; 89(6): 1002–1007.
19.	Ten Bokkel Huinink W, Lane SR, Ross GA, et al. Long-term survival in a phase III, randomised study of topotecan versus paclitaxel in advanced epithelial ovarian carcinoma. Annals of oncology, 2004; 15(1): 100–103.
20.	Ten Bokkel Huinink W, Gore M, Carminchael J, et al. Topotecan versus paclitaxel for the treatment of recurrent epithelial ovarian cancer. Clinical Oncology, 1997; 15(6): 2183–2193.
21.	Hoskins P, Eisenhauer E, Beare S, et al. Randomized Phase II Study of Two Schedules of Topotecan in Previously Treated Patients With Ovarian Cancer: A National Cancer Institute of Cancer Institute of Canada Clinical Trials Group Study. Clin Oncol, 1998; 16(6): 2233–2237.
22.	M Gore, A Ozab, G Rustinc, et al. A randomised trial of oral versus intravenous topotecan in patients with relapsed epithelial ovarian cancer. Eur. J Cancer, 2002; 38(32): 57–63.
23.	Markman M, Kennedy A, Webster K, et al. Phase 2 evaluation of topotecan administered on a 3-days schedule in the treatment of platinum- and paclitaxel-refractory ovarian cancer. Gynecol Oncol, 2000; 7766: 116–119.
24.	Levya T, Inbarb M, Menczera J, et al. Phase II study of weekly topotecan in patients with recurrent or persistent epithelial ovarian cancer. Gynecol Oncol, 2004; 95(186): 686–690.
25.	Johnson S, Pyle l, King K, et al. A phase II study of topotecan given as a continuous 21-day infusion every 28 days in platinum pre-treated ovarian carcinoma. Eur J Cancer, 1997; 58(78): abstr 537.
26.	–1597.

1. Thigpena JT, Aghajanianb CA, Albertsc DS, et al. Role of pegylated liposomal doxorubicin in ovarian cancer. Gynecologic Oncology, 2005; 68(96): 10–18.
2. Latorre A, De Lena M, Catino A, et al. Epithelial ovarian cancer-second and third line chemotherapy (review). Int J Oncol, 2002; 21(6): 179–186.
3. Ozols R.F, Update on the management of ovarian cancer. Cancer, 2002; 8(suppl 1): S22–30.
4. Gadducci A, Sartore E, Maggino T, et al. Analysis of failures after negative second-look in patients with advanced ovarian cancer: an Italian Multicenter study. Gynecol Oncol, 1998; 68(156): 150–155.
5. Swenerton K, Muss HB, Robinson EG. Salvage chemotherapy for refractory disease. In: Gershenson DM, McGuire WP: Ovarian cancer controversies on management. NY, Charchill livingstone, 1998: P169–194.
6. Parazzini F, Raspagliesi F, Guarnerio P, et al. Role of secondary surgery in relapsed ovarian cancer. Cri Rer Oncol Hematol, 2001; 32(25): 121–125.
7. Armstrong DK. Relapsed ovarian cancer: challenges and management strategies for a chronic disease. Oncologist, 2002; 7(suppl 5): 20–28.
8. National Institute for Clinical Excellence: Final Appraisal Determination. Ovarian cancer (advanced): topotecan, pegylated liposomal doxorubicin hydrochloridn and paclitaxel. NICE. March 2005.
9. Rustin GJS, Nelstrop ARE, McClean P, et al. Defining response of ovarian carcinoma to initial chemotherapy according to serum CA-125. Clin Oncol, 1996; 14(5): 1545–1551.
10. Rustin GJS, Nelstrop ARE, Crawford M, et al. Phase II trial of oral altretamine for relapsed ovarian carcinoma: Evaluation of defining response by serum CA-125. Clin Oncol, 1997; 15(1): 172–176.
11. Martin Gore, Wim ten Bokkel Huinink, James Carmichael, et al. Clinical Evidence for Topotecan-Paclitaxel Non-Cross-Resistance in Ovarian Cancer. Clin Oncol, 2001; 19(7): 1893–1900.
12. Gordon-AN, Fleagle-JT, Guthrie-D, et al. Recurrent Epithelial Ovarian Carcinoma: A Randomized Phase III Study of Pegylated Liposomal Doxorubicin Versus Topotecan. Clinical Oncology, 2001; 19(14): 3312–3322.
13. Smith DH, Adams JR, Johnston SR, et al. A comparative economic analysis of pegylated liposomal doxorubicin versus topotecan in ovarian cancer in the USA and the UK. Ann Oncol, 2002; 13(10):.
14. Cohen J: A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 1960; 20(42): 37–46.
15. Moher D, Pham B, Jones A, et al. Does quality of reports of randomized trials affectestimates of intervention efficacy reported in meta-analyses. Lancet, 1998; 352(9128): 609–613.
16. Gordon AN,Tonda M,Sun S, et al. Doxil Study 30-49 Investigators. Long-term survival advantage for women treated with pegylated liposomal doxorubicin compared with topotecan in a phase 3 randomized study of recurrent and refractory epithelial ovarian cancer. Gynecol Oncol, 2004; 95(1): 1–8.
17. Capri S, Cattaneo G. Cost-minimization analysis of pegylated liposomal doxorubicin versus topotecan for the treatment of ovarian cancer in Italy. Clin Ther, 2003; 25(6): 1826–1845.
18. Ojeda B, de Sande LM, Casado A, et al. Cost-minisation analysis of pegylated liposomal doxorubicin hydrochloride versus topotecan in the treatment of patients with recurrent epithelial ovarian cancer in Spain. Br. J Cancer, 2003; 89(6): 1002–1007.
19. Ten Bokkel Huinink W, Lane SR, Ross GA, et al. Long-term survival in a phase III, randomised study of topotecan versus paclitaxel in advanced epithelial ovarian carcinoma. Annals of oncology, 2004; 15(1): 100–103.
20. Ten Bokkel Huinink W, Gore M, Carminchael J, et al. Topotecan versus paclitaxel for the treatment of recurrent epithelial ovarian cancer. Clinical Oncology, 1997; 15(6): 2183–2193.
21. Hoskins P, Eisenhauer E, Beare S, et al. Randomized Phase II Study of Two Schedules of Topotecan in Previously Treated Patients With Ovarian Cancer: A National Cancer Institute of Cancer Institute of Canada Clinical Trials Group Study. Clin Oncol, 1998; 16(6): 2233–2237.
22. M Gore, A Ozab, G Rustinc, et al. A randomised trial of oral versus intravenous topotecan in patients with relapsed epithelial ovarian cancer. Eur. J Cancer, 2002; 38(32): 57–63.
23. Markman M, Kennedy A, Webster K, et al. Phase 2 evaluation of topotecan administered on a 3-days schedule in the treatment of platinum- and paclitaxel-refractory ovarian cancer. Gynecol Oncol, 2000; 7766: 116–119.
24. Levya T, Inbarb M, Menczera J, et al. Phase II study of weekly topotecan in patients with recurrent or persistent epithelial ovarian cancer. Gynecol Oncol, 2004; 95(186): 686–690.
25. Johnson S, Pyle l, King K, et al. A phase II study of topotecan given as a continuous 21-day infusion every 28 days in platinum pre-treated ovarian carcinoma. Eur J Cancer, 1997; 58(78): abstr 537.
26. –1597.

Chinese Journal of Evidence-Based Medicine

Topotecan for Recurrent Ovarian Cancer: A Systemic Review

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