title: Feasibility of extension of platinum-free interval with weekly bolus topotecan and subsequent platinum retreatment outcomes in recurrent ovarian cancer.
abstract: OBJECTIVE
  The goal of this study was to evaluate the outcomes and response in a cohort of patients with presumed platinum-sensitive disease who were subsequently retreated with platinum after receiving weekly bolus topotecan at the time of initial recurrence.
  
  
  METHODS
  A retrospective review of our institutional databases identified a cohort of platinum-sensitive women with recurrent ovarian and peritoneal carcinoma. Antitumor responses and toxicities were assessed for patients retreated with platinum-based chemotherapy following weekly bolus topotecan (4 mg/m²).
  
  
  RESULTS
  Twenty-six patients (median age 63 years, range 45-80 years) were identified. Advanced stage (III/IV) ovarian carcinoma was most common (96%). Residual disease after primary cytoreductive surgery was less than 1 cm in 65% of the cohort. Platinum retreatment was well tolerated. Grade 3 neutropenia occurred most commonly (8%) without any episodes of grade 4 myelotoxicity. Fatigue (12%) and hypersensitivity reaction (15%) were the most common non-hematologic toxicities during platinum retreatment. Of the 26 patients, 5 (19%) had a complete response, 5 (19%) had a partial response, 10 (39%) had stable disease, and 6 (23%) had progressive disease. Thirty-nine percent of patients with stable or progressive disease during weekly bolus topotecan responded to subsequent platinum retreatment. Response to platinum retreatment, treatment-free interval, and platinum-free interval was significant prognosticators for survival (P < 0.05).
  
  
  CONCLUSIONS
  The results of this retrospective analysis suggest that weekly bolus topotecan, as intervening non-platinum, may result in acceptable toxicities and response rates during platinum retreatment in platinum-sensitive relapsed ovarian or peritoneal carcinoma.
authors.affiliation: Wayne State University, Barbara Ann Karmanos Cancer Institute, Harper Professional Building, Detroit, MI, 48201, USA. csbryant@med.wayne.edu
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Bryant
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kumar
authors.forename: Whitney
authors.initials: W
authors.lastname: Spannuth
authors.forename: Jay P
authors.initials: JP
authors.lastname: Shah
authors.forename: Adnan R
authors.initials: AR
authors.lastname: Munkarah
authors.forename: Gunter
authors.initials: G
authors.lastname: Deppe
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Alvarez
authors.forename: Robert T
authors.initials: RT
authors.lastname: Morris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate; D059004:Topoisomerase I Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D019772:Topotecan / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D059004:Topoisomerase I Inhibitors; D019772:Topotecan; D016190:Carboplatin; D002945:Cisplatin