IP Topotecan

I have written you often over the past 8 years. This week I had an IP Port installed after 2 negative PtCts and and a CT scan revealed very little. With a CA125 of over 5,000 the doctor decided to do a Lap and take a look and install the port. The docor found some disease on the abdomen, nothing larger than 1 cm and a trace of fluid. They also decided to go with Topo three days in a row every 3-4 weeks. Do you have any experience with IP Topotcan and its effectiveness. Is the three day regimen very difficult?

[Annekathryn Goodman, M.D.]

Hi There,
thank you for the update.
I do not have experience with IP topotecan. I did find a reference that I have pasted below.  

I would say that you are doing very well. It is reassuring that you do not have much tumor. I wonder if another option is just watchful waiting. please keep us posted on how you are doing.
best wishes


Phase 2 study of intraperitoneal topotecan as consolidation chemotherapy in ovarian and primary peritoneal carcinoma.
Muntz HG, Malpass TW, McGonigle KF, Robertson MD, Weiden PL.

Cancer. 2008 Aug 1;113(3):490-6

BACKGROUND: Intravenous topotecan is approved for the treatment of ovarian cancer (OC). In intraperitoneal (i.p.) topotecan studies, 20 mg/m(2) dosing was tolerable. This study evaluated the feasibility, safety, and preliminary efficacy of i.p. topotecan as consolidation chemotherapy in patients with OC or primary peritoneal cancers (PPCs). METHODS: Patients with stage III/IV ovarian or PPC in clinical complete response after surgical cytoreduction and intravenous carboplatin/paclitaxel chemotherapy who had benign findings or minimal persistent disease (< or = 1 cm diameter) at second-look surgery were eligible. Intraperitoneal topotecan 20 mg/m(2) was infused once every 21 days for 4 to 6 cycles. Kaplan-Meier estimates were used to calculate progression-free survival (PFS) and overall survival (OS). RESULTS: Twenty patients were enrolled (18 [90%] patients had OC). Sixteen patients received 4 cycles, 3 patients received 6 cycles, and 1 patient withdrew after 1 cycle. The mean delivered dose was 18 mg/m(2). Grade 3/4 toxicities included neutropenia and thrombocytopenia (45% for both). Grade 1/2 abdominal distension and nausea were reported in 60% and 40% of patients, respectively. Median PFS was 24 months from second-look surgery (95% confidence intervals [CI]: +/-10 months). Sixteen patients were alive and median OS was not reached at the time of data analysis. OS estimated at either 30 months from second-look surgery, or 3 years from initial diagnosis, was 84% (95% CI, 68%-100%). CONCLUSIONS: Consolidation i.p. topotecan is a feasible option for women withadvanced ovarian and primary peritoneal cancers. Further investigation of i.p. topotecan is warranted in this patient population. (c) 2008 American Cancer Society