Schedule Optimization of Topotecan in the Therapy of Ovarian Cancer

Despite the increase in radical cytoreductive surgery and an initial high response rate to first-line chemotherapy with carboplatin plus paclitaxel, most women with ovarian cancer will relapse and die due to tumor progression. According to a survey performed by the NOGGO (Nord-Ostdeutsche Gesellschaft fur Gynakologische Onkologie), survival represents the most important goal of treatment for patients with platinum-sensitive relapse, while in platinum-resistant relapse there is a shift to providing disease control and symptom palliation with a generally well-tolerated regimen and an emphasis on the patients' quality of life. Thus, weekly topotecan dosing instead of the standard 5-day regimen offers a promising expansion of the therapeutic spectrum. The pharmacokinetic rationale for the weekly schedule is that the inhibiting effect of topotecan on topoisomerase I is reversible after one week. The results of the randomized phase-II study of the NOGGO, which investigated the weekly schedule in comparison to the conventional 5-day schedule of topotecan, are expected for the end of this year.