Trial of Topotecan following Carboplatin and Paclitaxel in treatment of ovarian cancer

The drug topotecan does not increase survival for ovarian cancer patients when used with standard chemotherapy in first-line treatment and is not recommended for future use, according to a phase III study in the August 2 issue of the Journal of the National Cancer Institute.

Standard treatment for advanced ovarian cancer involves a combination of carboplatin and paclitaxel. Past studies have shown that this treatment is effective and has low toxicity. However, cancer recurrence and death rates remain high.

Jacobus Pfisterer, M.D., of the Universtitatsklinikum Schleswig-Holstein in Kiel, Germany, and colleagues randomly assigned 1,308 patients with untreated ovarian cancer to receive paclitaxel and carboplatin followed by either topotecan or surveillance. The researchers wanted to know how the drug regimen affected overall survival, progression-free survival, and quality of life.

Topotecan followed by treatment with carboplatin and paclitaxel did not improve patients' length of survival or survival without cancer recurrence. Topotecan treatment increased the frequency of blood-related toxicities and infections, which require extra medical care. The authors suggest that topotecan should not be used as part of first-line treatment in ovarian cancer patients.

The authors write, "Carboplatin-paclitaxel remains the standard of care for patients with advanced ovarian cancer."

In an accompanying editorial, William P. McGuire, M.D., of the Weinberg Cancer Institute in Baltimore, Md., discusses problems with chemotherapy trials for ovarian cancer, and suggests targeted therapies, such as angiogenesis inhibitors should be considered for future trials. He writes, "It seems that we are at a turning point in the design of clinical trials for ovarian cancer. We can continue to ask easier and, in my opinion, less important questions [...] Or we can 'bite the bullet' and use all of our valuable patient resources to evaluate whether ovarian cancer responds to the targeted therapies as other solid tumors have."