Topotecan Use for Second-Line Treatment in Patients with Recurrent or Metastatic Cervical Cancer at Brazilian National Cancer Institute (INCA)*

Abstract

Cervical cancer represents the third most commonly diagnosed cancer and is an important cause of death for women suffering with malignancies. Patients who are refractory or progressed after first-line palliative treatment have a dismal prognosis and no second-line chemotherapy is considered standard so far. Several agents have been investigated in this setting and topotecan is one of the most characterized. The objective of this study was to evaluate response rate (RR), progression-free survival (PFS), overall survival (OS) and toxicity of topotecan in second palliative line for cer vical cancer. Methods: An analysis was performed of all patients with recurrent or metastatic cervical cancer treated with topotecan in second palliative line at Brazilian National Cancer Institute, between 2008 and 2010. Results: A total of 73 courses of topotecan were given in the current study (median: 3.5 cycles; range 1 - 6). Anemia was the most fre quent adverse event (grade 2:35%; grade 3:30%). Of the 20 patients evaluable, there were 2 partial responders to the treatment. The overall response rate (ORR) was 10%; 3 patients (15%) had stable disease as maximum response. The median PFS for the entire group was 2.93 months (95% CI 2.41 - 3.45) and OS was 4.66 months (95% CI 1.21 - 8.11). Conclusion: The limited activity of topotecan schemas in second-line treatment of cervical cancer and the associated overall toxicity may not justify their use in this setting. Patients who progress after first-line treatment may be offered participation in clinical trials, other second-line agents or best supportive care measures.