Tolerance and activity of oxaliplatin with protracted topotecan infusion in patients with previously treated ovarian cancer. A phase I study

• Published in: Gynecologic oncology Vol. 108; no. 3; pp. 500 - 504
• Main Authors: Hochster, Howard, Chen, Thomas T, Lu, Janice M, Hills, Day, Sorich, Joan, Escalon, Juliet, Ivy, Percy, Liebes, Leonard, Muggia, Franco
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2008
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - pathology; Adenocarcinoma, Papillary - drug therapy; Adenocarcinoma, Papillary - pathology; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cystadenocarcinoma, Serous - drug therapy; Cystadenocarcinoma, Serous - pathology; Drug Administration Schedule; Female; Hematology, Oncology and Palliative Medicine; Humans; Infusions, Intravenous; Middle Aged; Neoplasm Staging; Obstetrics and Gynecology; Organoplatinum Compounds - administration & dosage; Ovarian cancer; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - pathology; Oxaliplatin; Peritoneal Neoplasms - drug therapy; Peritoneal Neoplasms - pathology; Topotecan; Topotecan - administration & dosage; Treatment Outcome; Topotecan; Oxaliplatin; Ovarian cancer
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2007.11.017

Abstract Background. Topotecan 14-day infusion combined with cisplatin was highly active in ovarian cancer, but too myelosuppressive. We therefore sought to evaluate the feasibility of substituting oxaliplatin for cisplatin to improve safety. Methods. Ovarian and primary peritoneal cancer patients, pretreated with at least one prior platinum-containing regimen, performance status (PS) 0–1, without prior pelvic radiation were eligible. Topotecan was continuously infused days 1–15; oxaliplatin was given days 1 and 15; cycles were repeated every 28 days. Five dose levels were explored: topotecan (mg/m2 /day)/oxaliplatin (mg/m2 ) doses: (1) 0.2/65; (2) 0.2/75; (3) 0.2/85; (4) 0.3/85; (5) 0.4/85. Results. Twenty-three patients (20 ovarian, 1 tubal, and 2 peritoneal) were entered: median age 56 years (range, 37–77); PS: 0 = 12 and 1 = 11; histology: papillary serous 7, serous 4, adenocarcinoma 8, poorly differentiated 2. Median of 4 cycles were delivered. Grade 3 neutropenia occurred in 3 of 7 patients at level 5 (with fever at levels 4 and 5), without grade 4 neutropenia or thrombocytopenia. Other toxicities were mild and reversible (mainly gastrointestinal), except one grade 3 neuropathy and one oxaliplatin-related grade 3 hypersensitivity reaction. Six objective responses (five of them complete) were documented among 22 patients spanning several dose levels. Conclusion. Topotecan continuous infusion, combined with oxaliplatin, was associated with no grade 4 hematologic toxicity and evidence of activity. The recommended phase II dose is topotecan 0.4 mg/m2 /day continuous infusion d1–15 with oxaliplatin 85 mg/m2 on days 1 and 15. A phase II evaluation as second-line treatment for both platinum-sensitive and -resistant ovarian cancer recurrences is ongoing.