Navigation Links
Adding topotecan to standard treatment for ovarian cancer does not improve progression-free survival
Date:10/11/2010

Adding topotecan to carboplatin plus paclitaxel, the standard treatment for ovarian cancer, does not improve progression-free survival in patients and leads to greater toxicity, according to a study published online October 11 in the Journal of the National Cancer Institute.

Cisplatin plus paclitaxel, and carboplatin plus paclitaxel, are the most widely accepted first-line regimens for advanced epithelial ovarian cancer. Still, most women relapse and die from their disease. One possible solution is to add a third agent, such as topotecan, which has activity in the treatment of recurrent disease. However, combining topotecan with carboplatin plus paclitaxel as a triplet therapy is problematic because of bone marrow toxicity. So, to integrate topotecan into the standard regimen researchers tested cisplatin plus topotecan followed by carboplatin plus paclitaxel.

The phase III randomized study included 819 women aged 28-78 with newly-diagnosed stage IIB or more advanced ovarian cancer. The study was led by Paul Hoskins, M.D., of the British Columbia Cancer Agency in Vancouver and colleagues from three other groups: the NCIC Clinical Trials Group at Queen's University in Kingston, Canada, the European Organization for Research and Treatment of Cancer Gynecologic Cancer Group, European Union, and the Grupo Espańol de Investigacin en Cncer de Ovario in Spain.

The women in the study were from Canada and Europe, and were randomly assigned to one of two study groups: the first arm received cisplatin and topotecan, followed by carboplatin and paclitaxel; the second arm received only carboplatin and paclitaxel.

The researchers found that after a median follow-up of 43 months, 650 patients had disease progression and 406 had died. The progression-free survival of patients in the first arm was 14.6 months compared to 16.2 months for those in the second arm. Furthermore, although survival data were not mature, there is no evidence to date that patients receiving topotecan had improved survival (with a median overall survival of 42.3 months for patients in the first arm, compared to 42.1 months for those in the second).

Patients in the first arm also had more toxicity than those in the second. The common side effects included gastrointestinal symptoms, myelosuppression, neurological toxicity and myalgia. Patients in the first arm had more myelotoxicity, nausea and vomiting, while patients in the second had more neurosensory effects and allergic reactions.

The authors concluded that carboplatin plus paclitaxel remains the best standard of care for epithelial ovarian cancer stage IIB or greater. They write, "The most sensible explanation for this lack of additional benefit is that the topotecan does not have sufficient cytotoxic impact on cells that are truly refractory to platins or taxanes."

Furthermore, they explain that a drug such as topotecan needs to be effective in the refractory settingwhen the cancer grows during treatmentand not just in the resistant settingwhen it recurs shortly after the end of treatment. They write, "Further cytotoxic drugs need to be able to convincingly kill truly refractory cells before being added to the preexisting standard drug or drugs for efficacy testing."

In an accompanying editorial, William P. McGuire, M.D., of the Weinberg Cancer Institute at Franklin Square Hospital Center, Baltimore, writes that the trial provides further confirmation of the inactivity of topotecan to treat standard ovarian cancer. He writes, "In the end, neither the dose of topotecan, sequence of drug administration, nor platinum compound used in combination made any difference."

McGuire also points to the emergence of targeted therapies to treat ovarian cancer instead of cytotoxic agents. He writes, "Clearly, the lack of any benefit from adding topotecan, gemcitabine, or pegylated liposomal doxorubicin to the platinum/taxane in the intergroup trial has signaled the need to try new approaches."


'/>"/>

Contact: Caroline McNeil
jncimedia@oxfordjournals.org
301-841-1286
Journal of the National Cancer Institute
Source:Eurekalert

Related medicine news :

1. Adding Recess to the Workday Gains Backers
2. Ellsworth Adhesives Is Adding PRC Rapid Seal Product Line Offering
3. Adding Surgery to Meds May Improve Life With Parkinsons
4. Alzheimers Association Applauds Social Security Administration for Adding Early-Onset Alzheimers to Its Compassionate Allowances Initiative
5. Frequent inaccuracies in testosterone testing lead to call for standardization
6. The gold standard in cancer staging now as Web tool
7. ACGME board approves final duty hour and supervision standards for resident education
8. Clinical trial establishes catheter-based aortic valve replacement as new standard of care
9. Gold Standard/Elsevier first to launch state, federal controlled substance drug schedules
10. Gold Standard/Elsevier promotes medication safety and compliance via New MEDcounselor languages
11. New Features From CleanItSupply.com Set the Industry Standards for Product Availability, Knowledge, Pricing and Service
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:4/24/2017)... ... April 24, 2017 , ... A new global ... last decade, student well-being has seriously declined. "When disenfranchised youth from the heart ... the Islamic State to turn the historic multi-ethnic and multi-religious powerhouses of the ...
(Date:4/24/2017)... ... April 24, 2017 , ... “Learning to Use Your SPIRITUAL COMPASS ... “Learning to Use Your SPIRITUAL COMPASS To Navigate Life Issues” is the creation of ... Chairman of the Board of Directors for CONTACT USA, and former member of the ...
(Date:4/24/2017)... ... April 24, 2017 , ... Miami Periodontist and ... Oral Reconstruction Foundation’s 2017 Symposium on Tissue Regeneration and Implant Dentistry held in ... annual Global Symposium at the Fontainebleau Hotel located in Miami Beach, FL. This ...
(Date:4/24/2017)... , ... April 24, 2017 , ... ... brands, work wear distributors and International relief organizations across the globe to provide ... also offers lifestyle and work wear collections via insectshield.com . In the ...
(Date:4/24/2017)... ... ... A 2-in-1 bottleless water appliance provides both purified drinking ... here are the ways in which this technology can benefit dental offices: , ... oxygenated water, with both cold and hot options. , Convenience for Dentists and ...
Breaking Medicine News(10 mins):
(Date:4/20/2017)... PLANO, Texas , April 20, 2017  Vivify ... via mobile devices, has been awarded a very significant ... care via EMRs to continual care via digital health. ... of key intellectual property and further secures Vivify,s position ... Vivify, launched in 2009, was the first company to ...
(Date:4/20/2017)... , April 20, 2017  CVS Pharmacy, ... today unveiled a new store design to enhance ... of healthier food, health-focused products and expanded beauty ... to help customers discover new offerings. Together with ... next evolution of the customer experience at CVS ...
(Date:4/20/2017)... April 20, 2017 NeuroVive Pharmaceutical AB ... announced positive preclinical results demonstrating anti-fibrotic effects ... non-alcoholic steatohepatitis (NASH), in an additional well-validated ... NV556 has previously shown similar anti-fibrotic effects ... NeuroVive,s scientists present novel data demonstrating anti-fibrotic ...
Breaking Medicine Technology: