Response Rate Is Significantly Improved with Nab- vs Solvent-based Paclitaxel plus Carboplatin in Advanced NSCLC


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Taken together, the [nab-paclitaxel] regimen has a favorable risk-benefit profile compared with that of [solvent-based paclitaxel] as first-line therapy for all patients with NSCLC.

Final results of a phase III trial found nanoparticle albumin-bound (nab)-paclitaxel (Abraxane) plus carboplatin as first-line therapy in patients with advanced non–small cell lung cancer (NSCLC) resulted in a significantly improved overall response rate vs conventional solvent-based paclitaxel plus carboplatin. The study was published recently in the Journal of Clinical Oncology.1

Study Results

Overall response rate was 33% for nab-paclitaxel recipients compared to 25% for those on the conventional paclitaxel arm (P = .005). Patients receiving nab-paclitaxel also had nonsignificant improvements in progression-free survival (6.3 vs 5.8 months) and overall survival (12.1 vs 11.2 months).

“Patients with squamous cell histology responded remarkably well to treatment with [nab-paclitaxel/carboplatin], with a 68% improvement compared with that in the [solvent-based paclitaxel/carboplatin] arm, which is the highest reported in a phase III study in this patient population,” the trial investigators reported. “This is particularly intriguing because improved therapeutic options for the subset of patients with squamous histology are needed.”

Study Overview

The study involved 1,052 patients with stage IIIB to IV NSCLC who were previously untreated for metastatic disease. Patients were randomly assigned, 521 to receive 100 mg/m2 nab-paclitaxel weekly and carboplatin at area under the concentration-time curve (AUC) 6 once every 3 weeks, and 531 to receive 200 mg/m2 solvent-based paclitaxel plus carboplatin AUC 6 once every 3 weeks. The authors noted that preclinical models suggest that nab-paclitaxel may reach the tumor environment more efficiently than solvent-based paclitaxel and may be preferentially taken up by cancer cells.

“The [nab-paclitaxel/carboplatin] regimen produced less severe neuropathy, neutropenia, myalgia, and arthralgia compared with [solvent-based paclitaxel/carboplatin]. The increased risk of thrombocytopenia and anemia in the [nab-paclitaxel–containing] regimen was readily manageable,” the researchers reported. “Taken together, the [nab-paclitaxel] regimen has a favorable risk-benefit profile compared with that of [solvent-based paclitaxel] as first-line therapy for all patients with NSCLC,” the authors concluded. ■

Reference

1. Socinski MA, Bandarenko I, Karaseva N, et al: Weekly nab-paclitaxel in combination with carboplatin vs solvent-based paclitaxel plus carboplatin as first-line therapy in patients with advanced non–small cell lung cancer: Final results of a phase III trial. J Clin Oncol 30:2055-2062, 2012.



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