title: Sequence dependence of hematologic toxicity using carboplatin and topotecan for primary therapy of advanced epithelial ovarian cancer: a phase I study of the Gynecologic Oncology Group.
abstract: OBJECTIVE
  Selection of a feasible sequence and schedule of carboplatin in combination with topotecan for evaluation in advanced epithelial ovarian cancer (EOC).
  
  
  METHODS
  Women with stages III-IV EOC or primary peritoneal carcinoma without prior chemotherapy were assigned to consecutive cohorts evaluating a "forward" (carboplatin day 1, topotecan days 1-3), "reverse" (carboplatin day 3, topotecan days 1-3), or "extended reverse" sequence (carboplatin day 5, topotecan days 1-5). Patients received 4 cycles carboplatin-topotecan followed by 4 cycles carboplatin-paclitaxel. Feasibility was defined according to the cumulative proportion of patients with dose-limiting events (DLEs) during the first four cycles.
  
  
  RESULTS
  Sixty-eight patients were enrolled across 5 cohorts. The forward sequence demonstrated unacceptable hematologic DLEs at the lowest topotecan dose (0.75 mg/m2/day x 3 days). The reverse sequence was feasible at 1.25 mg/m2/day x 3 days, with only 1/15 patients experiencing a DLE within 4 cycles, and 14/15 patients were able to receive 4 subsequent cycles of carboplatin-paclitaxel. The extended reverse sequence was associated with excessive DLEs at 1.00 mg/m2/day x 5 days. Prophylactic hematopoietic growth factors were not required.
  
  
  CONCLUSIONS
  Higher doses of topotecan could be safely administered with reduced toxicity over multiple cycles using the reverse sequence, which was selected for phase III evaluation. The relative efficacy of the forward and reverse sequence is unknown.
authors.affiliation: Division of Medical Science, Fox Chase Cancer Center, Philadelphia, PA 19111, USA. michael.bookman@fccc.edu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Bookman
authors.forename: D Scott
authors.initials: DS
authors.lastname: McMeekin
authors.forename: Paula M
authors.initials: PM
authors.lastname: Fracasso
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006402:Hematologic Diseases / Q000139:chemically induced*; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D019772:Topotecan / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D019772:Topotecan; D016190:Carboplatin