A retrospective analysis of safety and efficacy of weekly nab-paclitaxel as second-line chemotherapy in elderly patients with advanced squamous non-small-cell lung carcinoma

Abstract

PurposeThe aim of this retrospective study was to investigate the anticancer effect and toxicity of weekly administered nab-paclitaxel as a second-line chemotherapy in elderly patients with relapsed squamous non-small-cell lung cancer (NSCLC).Patients and methodsWe retrospectively reviewed the treatment of 42 elderly patients with relapsed squamous NSCLC, who received nab-paclitaxel monotherapy as a second-line treatment from January 2010 to March 2014. A dose of 100 mg/m2 nab-paclitaxel was administered weekly on days 1, 8, and 15, followed by 1 week of rest. The protocol was maintained for at least two cycles.ResultsThe overall response rate (ORR) and the disease control rate (DCR) were 21.43% (9/42) and 47.62% (20/42), respectively. The median progression-free survival (PFS) and overall survival (OS) were 6.6 and 10.9 months, respectively. In the subgroup analysis, there was no significant difference in ORR, DCR, PFS, and OS, accounting for the first-line therapy factors (taxane agent, radiotherapy, or surgery). There was a statistically significant difference in DCR for stages III and IV (62.96% vs 20%, P=0.008), but there was no such difference in either PFS or OS. The ORR of 29 patients receiving more than three cycles of treatment was higher than that of those receiving less than three cycles of treatment (31.03% vs 0%, P=0.038), and there was a significant difference in PFS (7.6 vs 4.9 months, P=0.004) and OS (11.7 vs 8.9 months, P=0.002). No hypersensitivity reactions or treatment-related grade 4 adverse events were reported.ConclusionNab-paclitaxel monotherapy administered weekly at a dose of 100 mg/m2 is shown to be an effective and safe regimen for elderly patients with relapsed squamous NSCLC, especially for patients with stage III disease or good performance status.

The role of weekly nanoparticle albumin bound paclitaxel monotherapy as second line or later treatment for advanced NSCLC in China

“…3.6 months for ≥ third-line treatment; p = 0.78) [ 18 ]. The analysis in Chinese populations demonstrated that weekly administering Nab-PTX monotherapy (100 mg/m 2 on days 1, 8, and 15 of a 28-day cycle) as a second-line chemotherapy in elderly patients with squamous NSCLC was an effective and safe regimen for relapsed NSCLC in terms of ORR, DCR, PFS, and OS, regardless of prior taxane treatment according to the subgroup analysis ( p = 0.952) [ 20 ]. The median PFS in our study for patients with prior taxane treatment was similar to those without prior taxane treatment (median, 4.11 versus 4.54 months, p = 0.195).…”

“…While we found that Nab-PTX was most often prescribed as second-line or later treatment in clinic. Although a few studies [ 18 – 20 ] had reported that Nab-PTX as second line or later regimen of chemotherapy was effective in advanced NSCLC among Western populations and East Asia populations, and there was no significant difference, regardless of prior taxane treatment. While there has been no a standard usage of Nab-PTX for these patients.…”

“…In an open-label, multicenter, single-arm phase II study, weekly Nab-PTX (100 mg/m 2 on days 1, 8, and 15 of a 21-day cycle) for patients with previously treated advanced NSCLC (those who had received prior treatment with Sb-PTX were excluded), demonstrated promising activity and tolerant toxicity [ 21 ]. Additionally, previous study revealed that a single-agent Nab-PTX schedule of 260mg/m 2 on day 1 of a 21-day cycle was also demonstrated a favorable tolerability of the regime [ 20 ]. However, we found that patients with Nab-PTX (260mg/m 2 on day 1 of a 21-day cycle) treatment mostly needed dose reduction or delayed treatment, due to adverse events in clinic, and Nab-PTX (100 mg/m 2 on days 1, 8, and 15 of a 21-day cycle) regimen would increase patient’ hospitalization days for Nab-PTX (100 mg/m 2 on days 1, 8, and 15 of a 21-day cycle).…”

Nab-paclitaxel in combination with Bevacizumab in patients with non-squamous non-small cell lung cancer after failure of at least one prior systemic regimen

“…The results showed that the ORR and DCR were 26.5% and 82.4%, respectively; the median PFS and OS were 6.0 and 11.0 months, respectively. Previous studies of nab-PTX alone in second or further line treatment of NSCLC reported a PFS of 3.5-6.6 months and an OS of 6.8-15.7 months, with ORRs ranging from 16.1%-35.5% 27 , 28 , 37 - 40 . A study of nab-PTX combined with carboplatin reported a PFS of 4.0 months and an OS of 14.0 months 41 .…”

Nab-paclitaxel as First Line Treatment for NSCLC in Elderly Patients More Than 75 Years Old

“…There are data regarding second line treatment with nab-paclitaxel as second line treatment for the elderly, however; there are no data regarding whether it could be used as first line treatment. 8 Moreover; there are recently published data regarding the efficacy of nab-paclitaxel in combination with carboplatin for non-small cell lung cancer. 9 Nab-paclitaxel belongs to the taxane family, however; it is designed in a so that it has a local sustain release effect and deep penetration in tumor tissue.…”