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| |  ECCO11: Addition of Topotecan to Paclitaxel/Carboplatin Combo Reduces Toxicity, Maintains Efficacy for Advanced Ovarian Cancer By Ana Hidalgo-Simón LISBON, PORTUGAL -- October 25, 2001 -- A combination of paclitaxel and carboplatin followed by topotecan shows promising results for advanced ovarian cancer in patients who have unsuccessful surgery. The combination of paclitaxel and carboplatin is one of the most active first-line therapies for ovarian cancer. Topotecan is currently used as second line therapy. Researchers in five different centres in Spain undertook a phase II study to evaluate the clinical response and toxicity with paclitaxel/carboplatin followed by topotecan as first line therapy in patients with epithelial ovarian cancer sub-optimally debulked (International Federation of Gynecology and Obstetrics [FIGO] grade III-IV with residual disease larger than 1 cm). Dr. José Ángel Arranz, from the Hospital Gregorio Marañon, in Madrid, Spain, presented the findings yesterday (Oct. 24) at ECCO 11, the European Cancer Conference, in Lisbon, Portugal. Treatment consisted of two courses of paclitaxel 60 mg/mē weekly plus intravenous carboplatin at an area under the curve (AUC) of 2, in one hour (six doses each course) separated by a 14-day rest period, followed by four courses of topotecan 1.5 mg/mē daily for five days every three weeks. Fifty patients have completed the study therapy described. Mean age was 58 years and disease stage was III and IV (in 78 percent and 22 percent of cases, respectively). Response rates after paclitaxel/carboplatin were 82 percent for overall clinical response, 36 percent for complete response and 46 percent for partial response. After therapy with paclitaxel/carboplatin followed by topotecan, clinical response was 78 percent (overall), complete response was 48 percent and partial response was 30 percent. Fourteen patients received consolidation therapy and 19 second-line therapies. Fifteen patients have died due to their cancer, and the median follow-up was 15 months. Two-year overall survival was 76 percent. Toxicity of grade 3/4 for paclitaxel/carboplatin followed by topotecan were neutropenia (23 percent and 40 percent, respectively), anaemia (2-13 percent), thrombocytopenia (4-11 percent), alopecia (37-70 percent) and nephrotoxicity (2-NA). This toxicity is lower than that seen with paclitaxel/carboplatin alone in other regimens, the researchers found. The sequential administration of topotecan could also be less toxic than when used as second- or third-line therapy. "In this population the overall response is similar to that obtained with other therapies, and the complete response is 12 percent better," Dr. Arranz said. "The lower toxicity is probably explained by the different dose structure -- more intense but in shorter periods."
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