A Meta-analysis Of Topotecan For Recurrent Ovarian Cancer

ObjectiveTo evaluate the efficacy and safety of topotecan in the treatment of recurrent ovarian cancer.MethodWe searched Pub Med database, EMBase database, the Cochrane Library by English, Wanfang database, CNKI and CBMDisc by Chinese on the internet. Journals concerning Gynecological malignacies were searched manually in the library of Shandong University. Languages were restricted to Chinese and English. RCTs of chemotherapy comparing topotecan with other agents for recurrent epithelial ovarian cancer were included. We collected randomized controlled trials comparing topotecan with other anti-cancer agents or comparing various plans and routes of administration for epithelial ovarian cancer. Extraction of the data and assessment about the quality were performed independently by the author. The calculation and statistical tests of the data were carried out with the application of RevMan4.2.7software.ResultsSix RCTs involving1551eligible patients were included. Two of the RCTs aim to compare TPT with PLD and TAX in the efficacy and safety; one RCT aims to compare TPC with PC in the efficacy and safety; the other three RCTs have access to compare different dosage or plans and routes of administration.(1) Comparing TPT and PLD, there were no statistical significance in the remission rate and clinical benefit rate. TPT prolongs the overall survival for platinum-sensitive ROC patients, but increase the grade3to4toxicity of hematology with statistical significance.(2) Comparing TPT and TAX, there were no statistical significance in the remission rate and stable disease. With higher clinical benefit rate statistically, the grade3to4hematological toxicity of TPT is higher than TAX. TPT also prolongs overall survival for patients with platinum-resistant ROC.(3) Addition of TPT to standard PC plan for ROC, there is no significant benefit in remission rate, stable disease and clinical benefit rate, the toxicity of hematology increases at the same time.(4) Comparing standard5-day plan with24-hour continuous plan and3-week plan of TPT, the standard5-day plan has the strongest toxicity of hematology. Meanwhile24-hour continuous plan decreases the remission rate with statistical significance comparatively.(5) Comparing the intravenous route and oral route, the latter have weaker3/4neutropenia and longer overall survival with statistical significance.ConclusionIn the ROC chemotherapy, the curative effect of TPT is considerated equally to PLD and better than TAX. The long-term survival rate and OS for platinum-sensitive ROC are lower. The hematological toxicity of TPT is higher than TAX and PLD. Considering curative effect and toxic reaction, standard TPT weekly plan is recommended in the second-line chemotherapy, especially for platinum-resistant and refractory ROC.