Duration of chemotherapy with topotecan influences survival in recurrent ovarian cancer:: A meta-analysis

Objective: This meta-analysis compares the feasibility, safety and clinical outcome of long-term therapy with topotecan vs. standard treatment duration in patients with recurrent ovarian cancer. Materials and Methods: Data of 523 patients from five clinical trials were reviewed and retrospectively allocated into two groups. Those patients who received 6 or fewer courses were compared to those with 7 or more courses of intravenous topotecan. Response rates, overall survival and toxicity profiles were compared between these groups. Results: One hundred and fifty-two (29%) patients received 7 or more courses and 371 patients (71%) received up to 6 courses of topotecan. Hematological toxicity was significant but similar in both treatment groups and was not cumulative. Non-hematological toxicity was generally mild. Eighty-seven (17%) patients responded to topotecan treatment, 66 of these patients received 7 or more courses of therapy. In total, 14 patients experienced their initial response at or after course 6 of therapy. Within the subset of patients with response or disease stabilization at course 6, those who stopped treatment at course 6 for reasons other than progressive disease or adverse events had a median survival of 83.6 weeks and those who continued treatment for longer than 6 courses had a significantly longer median survival of 107.0 weeks. Conclusion: Chemotherapy with 7 or more courses of topotecan in recurrent ovarian cancer is feasible with no evidence of cumulative toxicity. The results of this retrospective analysis suggest a potential for late response and a survival benefit for those patients without disease progression who continue topotecan therapy beyond 6 cycles of treatment.