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Efficacy and tolerability of lower-dose topotecan in recurrent ovarian cancer: a retrospective case review
  1. S. K. MITCHELL,
  2. L. F. CARSON,
  3. P. JUDSON and
  4. L. S. DOWNS JR
  1. Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota Medical School, Minneapolis, Minnesota
  1. Address correspondence and reprint requests to: Suann K. Mitchell, RN, CCRP, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Mayo Mail Code 395, 420 Delaware Street, Minneapolis, MN 55455, USA. Email: mitch016{at}


Topotecan (1.5 mg/m2/day for 5 consecutive days of a 21-day cycle) is an established recurrent ovarian cancer treatment, but myelosuppression can be dose limiting. This study evaluates the activity and tolerability of low-dose topotecan in our clinical experience. Case records were reviewed for patients with recurrent ovarian cancer in first through third relapse. Eligible patients had received ≥2 cycles of ≤1.25 mg/m2 topotecan. Adverse events were evaluated using laboratory and clinical evaluation data. Twenty-seven eligible patients, most with advanced disease, received a total of 209 cycles (median, six cycles). Grade 3 or 4 hematologic toxicities during 184 cycles in 24 assessed patients were neutropenia, leukopenia, thrombocytopenia, and anemia in 35%, 28%, 36%, and 11% of cycles, and 21, 19, 16, and 10 patients, respectively. Only four grade 4 toxicities occurred: anemia (one) and thrombocytopenia (three). Myelosuppression was reversible, noncumulative, and manageable. Moreover, nonhematologic toxicity was generally mild to moderate, and the only two grade 3 events were constipation and deep vein thrombosis. Low-dose topotecan was active in this setting. Lower-dose topotecan is generally well tolerated and active in patients with pretreated ovarian cancer. Prospective clinical trials of low-dose topotecan in recurrent ovarian cancer are warranted.

  • alternate dosing
  • myelosuppression
  • ovarian cancer
  • topoisomerase I
  • topotecan

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