재발성 상피성 난소암 환자에서 이차항암화학요법으로투여한 Topotecan의 효용성
The role of topotecan as second-line chemotherapy in patients with recurrent epithelial ovarian cancer
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
목적: 저자는 platinum 제제를 기본으로 한 항암화학요법 후 재발한 난소암 환자들을 대상으로, topotecan 포함 항암화학요법의 치료 효과 및 부작용을 연구함으로써 임상적 유용성을 평가하고자 하였다. 연구 방법: 1998년 1월부터 2004년 1월까지 상피성 난소암으로 진단되어 종양감축술을 시행받은 후 platinum 제제를 기본으로 한 항암화학요법으로 치료받고 재발한 환자 중 topotecan 포함 항암화학요법을 2차례 이상 사용한 환자 57명을 대상으로 하였다. 치료에 대한 반응은 RECIST 기준을 적용하였고, 부작용은 GOG 기준에 따라 평가하였다. 결과: 전체 반응률은 19.3% (11/57)이었으며, platinum 반응군에서는 30.8% (4/13), platinum 저항군에서는 15.9% (7/44)의 반응률을 보였다. Topotecan 단독요법을 투여한 군은 8.0% (2/25), topotecan 복합요법을 투여한 군에서는 28.1% (9/32)의 반응률을 보였다 (P=0.09). 그리고 topotecan 복합요법이 단독요법을 투여한 군보다 통계적으로 유의하지는 않지만 2개월 정도의 평균 생존기간의 연장을 보였다 (P=0.82). Grade 3 이상의 과립구 감소증이 70%, Grade 3 이상의 빈혈이 36.8%, Grade 3 이상의 혈소판 감소증은 47.3%에서 보였다. 골수억제가 중요한 부작용이었지만 G-CSF 투여나 수혈을 통하여 회복한 후 항암화학요법이 가능하였다. 결론: 진행성 난소암 환자에서 platinum 제제를 기본으로 한 항암화학요법 후 재발한 경우 topotecan 항암화학요법이 유용한 치료 방법으로 사용될 수 있을 것으로 사료된다. 그리고 향후 다양한 항암약제와의 병합요법의 시도를 통해서 재발성 난소암 환자의 반응률을 높일 수 있을 것으로 생각된다.
Abstract
Objective: Topotecan has recently been used as a second-line agent in treatment of advanced ovarian cancer. The aim of the study was to evaluate the response rate and toxicities of topotecan in patients with recurrent epithelial ovarian cancer who had been treated with platinum-containing chemotherapy. Methods: A retrospective review of all cases of recurrent ovarian cancer treated with topotecan was done. Response was evaluated using the clinical examination, CA-125 level and radiologic reports (CT, MRI) according to RECIST criteria. The toxicities were evaluated according to GOG criteria. Results: Between 1998 and 2004, 57 patients were treated with topotecan for recurrent epithelial ovarian cancer. The response rate in platinum-sensitive group was 30.8% (4/13) and the response rate in platinum-resistant group was 15.9% (7/44). The response rate in topotecan alone therapy group was 8.0% (2/25), and the response rate in topotecan plus platinum combination therapy group was 28.1% (9/32). However, topotecan plus platinum combination therapy did not demonstrate a statistically significant trend toward greater median survival than topotecan alone therapy (19.2 month versus 17.2 month, P=0.82). Neutropenia above grade 3 was noted in 70%, and anemia above grade 3 in 36.8%, and thrombocytopenia above grade 3 in 47.3%. Although most severe toxicities were due to bone marrow suppression, they were adequately managed by supportive care. Conclusion: The results suggest that topotecan has moderate activity in the recurrent epithelial ovarian cancer who have failed previous treatment with platinum-containing chemotherapy. The response of topotecan plus platinum combination therapy was better than topotecan alone and the potential of other combination regimen deserves further evaluations.
참고문헌 (28)
- 대한민국 보건복지부, "한국인 중앙 암등록사업 연례보고서" (2002)
- Ozols RF, "Principles and Practice of Oncology", 2, pp.1597~632 (2001), Lippincott Williams & Wilkins 2001
- Ozols RF, "Update of the NCCN ovarian cancer practice guidelines", 11, pp.95~105 (1997)
- Kavanagh JJ, "Phase Ⅱ study of docetaxel in patients with epithelial ovarian carcinoma refractory to platinum", 2, pp.837~42 (1996), Clin Cancer Res
- Rose PG, "Prolonged oral etoposide as second-line therapy for platinum-resistant and platinum- sensitive ovarian carcinoma", 16, pp.405~10 (1998)
- Lund B, "Phase Ⅱ study of gemcitabine in previously treated ovarian cancer patients", 86, pp.1530~3 (1994)
- Markman M, "second-line treatment of ovarian cancer with single-agent gemcitabine", 29, pp.9~10 (2002)
- Zorrilla M, "Phase Ι trial of weekly gemcitabine at 3-h infusion in refractory", 12, pp.713~7 (2001)
- Gordon AN, "Recurrent epithelial ovarian carcinoma:a randomized phase Ш study of pegylated liposomal doxorubicin versus topotecan", 19, pp.3312~22 (2001)
- Burris HA, "Clinical trials with topoisomerase inhibitor", 19(6), pp.663~9 (1992)
- Therasse P, "New guidelines to evaluate the response to treatment in solid tumors", 92(3), pp.205~16 (2000)
- Creemers GJ, "an active drugs in the second-line treatment of epithelial ovarian cancer results of a large European phase Ⅱ study", 14, pp.3056~61 (1996)
- Kudelka AP, "phase Ⅱ study of intravenous topotecan as a 5-day infusion for refractory epithelial ovarian carcinoma", 14, pp.1552~7 (1996)
- Swisher EM, "Topotecan in platinum and paclitaxel-resistant ovarian cancer", 66, pp.480~6 (1997)
- Bookman MA, "Topotecan for the treatment of advanced epithelial ovarian cancer:an open-label phaseⅡ study in patients treated after prior chemotherapy that contained cisplatin or carboplatin and paclitaxel", 16, pp.3345~52 (1998)
- McGuire WP, "Topotecan has substantial antitumor activity as first-line salvage therapy in platinum-sensitive epithelial ovarian carcinoma:a Gyneologic Oncology Group study", 18, pp.1062~7 (2000)
- Cesano A, "Stabilization of disease as a useful predictor of survival following second-line chemotherapy in small cell lung cancer and ovarian cancer patients", 15, pp.1233~8 (1999)
- 최현수, "Taxol-cisplatin 화학 요법에 실패한 말기 난소암 환자에서 Topotecan으로 완전 관해된 1예", 43, pp.914~7 (2000)
- Ten Bokkel Huinink W, "Topotecan versus paclitaxel for the treatment of recurrent epithelial ovarian cancer", 15, pp.2183~93 (1997)
- Gore M, "Clinical evidence for topotecan-paclitaxel non- cross-resistance in ovarian cancer", 19, pp.1893~900 (2001)
- Ross G, "Long term survival in a phase Ⅲ randomized study of topotecan" (2001)
- Silvana C, "Topotecan and ifosphamide as salvage treatment in advanced ovarian cancer", 93, pp.474~8 (2004)
- Jalid S, "A new therapeutic approach:Topotecan plus gemcitabine in the treatment of patients with relapsed ovarian cancer after failure of first-line chemotherapy with paclitaxel and platinum", 29, pp.123~31 (2003)
- Armstrong DK, "Topotecan dosing guidelines in ovarian cancer:Reduction and management of hematologic toxicity", 9, pp.33~42 (2004)
- Amstrong D, "Clinical guidelines for managing topotecan- related hematologic toxicity", 3, pp.4~10 (1998)
- Zafiropoulos A, "Topotecan in heavily pretreated platinum resistant ovarian cancer patients 10th Symposium of New Drugs in cancer Therapy" (1998)
- Brown JV 3rd, "Three consecutive-day topotecan is an active regimen for recurrent epithelial ovarian cancer", 88, pp.136~40 (2003)
- Hoskins P, "Randomized phase Ⅱ study of two schedules of topotecan in previously treated patients with ovarian cancer:a National Cancer Institute of Canada Clinical Trial Group study", 16, pp.2233~7 (1998)