Objective: 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 cervical 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 frequent 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.
Cite this paper
L. Oliveira, F. Alves, P. Mora, C. Carmo, A. Nogueira-Rodrigues, A. Garces and A. Melo, "Topotecan Use for Second-Line Treatment in Patients with Recurrent or Metastatic Cervical Cancer at Brazilian National Cancer Institute (INCA)," Journal of Cancer Therapy
, Vol. 4 No. 6, 2013, pp. 1095-1099. doi: 10.4236/jct.2013.46126
  J. Ferlay, H. R. Shin, F. Bray, D. Forman, C. Mathers and D. M. Parkinm “GLOBOCAN 2008 v2.0, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 10,” International Agency for Research on Cancer, Lyon, 2010. http://globocan.iarc.fr
 J. Coronel, L. Cetina, M. Candelaria, A. González-Fierro, D. Arias, D. Cantu, et al., “Weekly Topotecan as Secondor Third-Line Treatment in Patients with Recurrent or Metastatic Cervical Cancer,” Medical Oncology, Vol. 26, No. 2, 2009, pp. 210-214.
 L. A. G. Ries, M. P. Eisner, C. L. Kosary, B. F. Hankey, B. A. Miller, L. Clegg, et al., “SEER Cancer Statistics Review, 1973-1998,” National Cancer Institute, Bethesda, 2012.
 J. V. Fiorica, J. A. Blessing, L. V. Puneky, A. A. Secord, J. S. Hoffman, S. D. Yamada, et al., “A Phase II Evaluation of Weekly Topotecan as a Single Agent Second Line Therapy in Persistent or Recurrent Carcinoma of the Cervix: A Gynecologic Oncology Group Study,” Gynecologic Oncology, Vol. 115, No. 2, 2009, pp. 285-289.
 P. Boabang, C. M. Kurbacher, H. Kohlhagen, A. Waida and B. K. Amo-Takyi, “Anti-Neoplastic Activity of Topotecan versus Cisplatin, Etoposide and Paclitaxel in Four Squamous Cell Cancer Cell Lines of the Female Genital Tract Using an ATP-Tumor Chemosensitivity Assay,” Anticancer Drugs, Vol. 11, No. 10, 2000, pp. 843-848.
 K. Noda, H. Sasaki, K. Yamamoto, T. Yamamoto, R. Nishimura, T. Sugiyama, et al., “Phase II Trial of Topotecan for Cervical Cancer of the Uterus,” Proceedings of the American Society of Clinical Oncologists, Vol. 15, 1996, p. 754.
 M. A. Bookman, J. A. Blessing, P. Hanjani, T. J. Herzog and W. A. Andersen, “Topotecan in Squamous Cell Carcinoma of the Cervix: A Phase II Study of the Gynecologic Oncology Group,” Gynecologic Oncology, Vol. 77, No. 3, 2000, pp. 446-449. doi:10.1006/gyno.2000.5807
 N. R. Abu-Rustum, S. Lee and L. S. Massad, “Topotecan for Recurrent Cervical Cancer after Platinum-Based Therapy,” International Journal of Gynecological Cancer, Vol. 10, No. 4, 2000, pp. 285-288.
 D. H. Moore, J. A. Blessing, R. P. McQuellon, H. T. Thaler, D. Cella, J. Benda, et al., “Phase III Study of Cisplatin with or without Paclitaxel in Stage IVB, Recurrent, or Persistent Squamous Cell Carcinoma of the Cervix: A Gynecologic Oncology Group Study,” Journal of Clinical Oncology, Vol. 22, No. 15, 2004, pp. 3113-3119.
 H. J. Long III., “Management of Metastatic Cervical Cancer: Review of the Literature,” Journal of Clinical Oncology, Vol. 25, No. 20, 2007, pp. 2966-2974.
 F. Zagouri, T. N. Sergentanis, D. Chrysikos, M. Filipits and R. Bartsch, “Molecularly Targeted Therapies in Cervical Cancer. A Systematic Review,” Gynecologic Oncology, Vol. 126, No. 2, 2012, pp. 291-303.
 B. J. Monk, M. W. Sill, R. A. Burger, H. J. Gray, T. E. Buekers and L. D. Roman, “Phase II Trial of Bevacizumab in the Treatment of Persistent or Recurrent Squamous Cell Carcinoma of the Cervix: A Gynecologic Oncology Group Study,” Journal of Clinical Oncology, Vol. 27, No. 7, 2009, pp. 1069-1074.
 A. Nogueira-Rodrigues, C. C. Carmo, C. Viegas, F. Erlich, C. Camis?o, K. Font?o, et al., “Phase I Trial of Erlotinib Combined with Cisplatin and Radiotherapy for Patients with Locally Advanced Cervical Squamous Cell Cancer,” Clinical Cancer Research, Vol. 14, No. 19, 2008, pp. 6324-6329. doi:10.1158/1078-0432.CCR-07-5112