Topotecan and liposomal doxorubicin in recurrent ovarian cancer: is sequence important?

Abstract.   Dupont J, Aghajanian C, Andrea G, Lovegren M, Chuai S, Venkatraman E, Hensley M, Anderson S, Spriggs D, Sabbatini P. Topotecan and liposomal doxorubicin in recurrent ovarian cancer: is sequence important? Int J Gynecol Cancer 2006; 16(Suppl. 1): 68–73.
A variety of agents have emerged to treat patients with recurrent epithelial ovarian cancer (EOC). Most patients receive both topotecan (T) and liposomal doxorubicin (D); however, there are no data regarding the benefit of a sequence—D followed by T (DT) or T followed by D (TD). We identified 89 consecutive patients with recurrent EOC, who received both D and T from January 1994 to January 2004 at Memorial Hospital. We compared the duration of treatment, toxicity, and overall survival (OS) for patients who received either DT or TD. Sixty-four patients received DT, and 25 patients received TD. The groups were balanced regarding age, stage, surgical debulking, platinum sensitivity, prior therapy, and intervening drugs between D and T. Median numbers of cycles on DT and TD were seven and six, respectively ( P = 0.61); there was no difference in duration based on platinum sensitivity. Removal from therapy for toxicity was similar, DT (22%) and TD (36%) ( P = 0.18). Finally, there was no difference in median OS based on sequence, DT (18.28 months) and TD (17.75 months) ( P = NS). Platinum sensitivity did not affect median OS based on sequence. Based on duration, toxicity, and OS there is no advantage of one sequence of D and T when treating patients with recurrent EOC.