title: Costs of treatment and outcomes associated with second-line therapy and greater for relapsed ovarian cancer.
abstract: OBJECTIVE
  Most women with epithelial ovarian cancer (EOC) will develop disease progression or recurrence with resistance to platinum therapy. We report overall costs and treatment outcomes associated with topotecan or gemcitabine administration in platinum- and paclitaxel-resistant EOC patients.
  
  
  METHODS
  Patients who received topotecan (n = 51) or gemcitabine (n = 56) as second-line therapy or greater for platinum- and paclitaxel-resistant EOC were retrospectively identified. Per patient costs for each regimen were determined and compared.
  
  
  RESULTS
  The mean total direct cost per cycle per patient of gemcitabine was $2732.28, with a median total direct cost per cycle of $1382.73. The mean total direct cost per cycle per patient of topotecan was $7832.07, with a median total direct cost per cycle of $4219.02. By comparison of the means, total direct cost per cycle per patient was significantly more expensive for topotecan (P = 0.001). Fifty-six patients received a total of 415 cycles of gemcitabine, median 5 cycles per patient (range, 1-59). Thirteen (23.2%; 95% CI, 11.9-34.5%) of 56 patients displayed clinical benefit, with median PFS of 1.8 months and median overall survival (OS) of 8.2 months. Fifty-one patients received topotecan, for a total of 264 cycles, median 4 cycles per patient (range, 1-42). Twenty-eight (56%; 95% CI, 42.0-70.0%) of 50 patients achieved clinical benefit, with PFS and OS medians of 3.6 and 16.8 months, respectively.
  
  
  CONCLUSIONS
  Gemcitabine and topotecan are active agents in heavily pretreated, platinum- and paclitaxel-resistant EOC patients. Topotecan was more costly to deliver. Although a larger percentage of patients received clinical benefit with topotecan use, this likely reflects physician selection for use of topotecan earlier in the course of disease.
authors.affiliation: Developmental Chemotherapy Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021,USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Prasad
authors.forename: Leah
authors.initials: L
authors.lastname: Ben-Porat
authors.forename: Brad
authors.initials: B
authors.lastname: Hoppe
authors.forename: Carol
authors.initials: C
authors.lastname: Aghajanian
authors.forename: Paul
authors.initials: P
authors.lastname: Sabbatini
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Chi
authors.forename: Martee L
authors.initials: ML
authors.lastname: Hensley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D016527:Drug Costs; D019008:Drug Resistance, Neoplasm; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000191:economics*; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000191:economics*; D017239:Paclitaxel / Q000627:therapeutic use; D016879:Salvage Therapy / Q000191:economics*; D019772:Topotecan / Q000191:economics / Q000627:therapeutic use; D000093542:Gemcitabine
chemical_list: D009944:Organoplatinum Compounds; D003841:Deoxycytidine; D019772:Topotecan; D017239:Paclitaxel; D000093542:Gemcitabine