SECOND-LINE TREATMENTS FOR ADVANCED OVARIAN CANCER
Topotecan, pegylated liposomal doxorubicin hydrochloride (PLDH) and paclitaxel for second-line or subsequent treatment of advanced ovarian cancer: a systematic review and economic evaluation
Background
The objectives of this review were to examine the clinical effectiveness and cost-effectiveness of intravenous formulations of topotecan monotherapy, PLDH monotherapy and paclitaxel used alone or in combination with a platinum-based compound for the second-line or subsequent treatment of advanced ovarian cancer.Findings
For participants with platinum-resistant disease there is a low probability of response to treatment with PLDH, topotecan or paclitaxel, and little difference between them in relation to overall survival. The comparators do, however, differ considerably in their toxicity profiles.
For participants with platinum-sensitive disease there is a considerable range of median survival times observed across the trials. The most favourable survival times and response rates are observed for paclitaxel and platinum combination therapy. Toxicity profiles again vary significantly.
Patient and physician choice as to the potential toxicities associated with each of the comparators and the patient's ability and willingness to tolerate these are of importance. PLDH appears to be cost-effective compared with topotecan and paclitaxel monotherapy. For platinum-sensitive patients, the combination of paclitaxel and platinum appears to be cost-effective.
Conducted by: C Main1, L Bojke2, S Griffin2, G Norman1, M Barbieri3, L Mather1, D Stark4, S Palmer2, R Riemsma11. Centre for Reviews and Dissemination;
2. Centre for Health Economics, University of York;
3. Economic and Health Research Centre, Universitat Pompeu Fabra;
4. Department of Oncology, Bradford Royal Infirmary
Further details
Project page on HTA Programme website
Related guidance
Commissioned to inform NICE Technology Appraisal 91: Topotecan, pegylated liposomal doxorubicin hydrochloride and paclitaxel for the treatment of advanced ovarian cancer (review of TA28, TA45 and TA55 (for relapsed disease only)). London: National Institute for Clinical Excellence; 2006. 5Publications
Main C, Ginnelly L, Griffin S, Norman G, Barbieri M, Mather L, Stark D, Palmer S, Riemsma R. A systematic review of the clinical effectiveness and cost effectiveness of topotecan, pegylated liposomal doxorubicin hydrocholoride and paclitaxel for second-line or subsequent treatment of advanced ovarian cancer (up-date). Health Technol Assess. 2006;10(9):1-173
Griffin S, Bojke L, Main C, Palmer S. Incorporating direct and indirect evidence using Bayesian methods: an applied case study in ovarian cancer. Value Health. 2006;9(2):123-31Presentations
Main C, Norman G, Riemsma R, Mather L. A systematic review of topotecan, pegylated liposomal doxorubicin and paclitaxel for second-line or subsequent treatment of advanced ovarian cancer. Health Technology Assessment International (HTAi) Annual Meeting; 2005 June; Rome, ItalyFunding
Commissioned by the HTA Programme on behalf of NICE
Status: Completed