The use of topotecan for relapsed ovarian cancer in accordance with the National Institute for Clinical Excellence guidance 2001: The Nottingham experience

Aims: The topoisomerase-1 inhibitor, topotecan, is an established chemotherapy agent for the treatment of relapsed ovarian cancer after the failure of platinum-based chemotherapy, and is an established treatment choice at first relapse. In line with National Institute for Clinical Excellence (NICE) guidance, topotecan has been used at Nottingham City Hospital for the last 2 years. Materials and methods: A retrospective audit, over the period September 2001 to September 2002, was carried out to assess response rates and side-effects for patients with relapsed ovarian cancer who were treated with topotecan. Twenty-five patients received topotecan as a 30min intravenous infusion for 5 consecutive days, every 21 days. The starting dose was either 1.5 mg/m(2) /day (n = 22) or 1.25 mg/m(2)/day (n = 3). Patient response was monitored by physical examination and serological CA125 tumour marker level. Radiological assessment was by computed tomography. Results: Eighteen (72%) patients had their previous platinum-based treatment less than 6 months before topotecan therapy. Thirteen patients received topotecan therapy as second-line, seven as third-line and five as greater than or equal to fourth-line treatment. Twenty-two (88%) patients who received more than one cycle of chemotherapy were evaluable for response. A clinical benefit was observed in 11 (44%) patients (two [8%] partial response and nine [36%] stable disease). Seven patients achieving clinical benefit received topotecan as second-line treatment. Dose was reduced from 1.5 to 1.25 mg/m(2)/day in six patients after the first cycle of topotecan. Twelve (48%) patients had dose delay of at least 1 week. Grade 3/4 neutropenia, observed in nine (36%) patients, was the main dose-limiting toxicity. One patient died as a result of treatment. Conclusion: The Nottingham experience with topotecan in platinum-resistant ovarian cancer has been encouraging, even in such a heavily pre-treated patient population. There is a better chance of response if the patients receive topotecan at first relapse. The haematological toxicity is significant but manageable with dose reduction and dose delay. (C) 2004 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.