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Cancer. 2020 Mar 1;126(5):1060-1067. doi: 10.1002/cncr.32573. Epub 2020 Jan 14.

Nab-paclitaxel in older patients with non-small cell lung cancer who have developed disease progression after platinum-based doublet chemotherapy.

Author information

1
Department of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
2
Hematology and Medical Oncology, Cleveland Clinic, Cleveland, Ohio.
3
Oncology Division, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
4
Highlands Oncology, Fayetteville, Arkansas.
5
Rex Hematology Oncology Associates, Raleigh-Durham, North Carolina.
6
Department of Medical Oncology, Swedish Cancer Institute, Seattle, Washington.
7
Medical Oncology, Bon Secours, Midlothian, Virginia.
8
Florida Hospital Cancer Institute, Orlando, Florida.
9
Division of Medical Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina.
10
Division of Hematology/Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania.

Abstract

BACKGROUND:

The selection of later-line treatment for older patients with AJCC (version 7) stage IV non-small cell lung cancer (NSCLC) remains controversial. Nanoparticle albumin-bound (nab)-paclitaxel is approved with carboplatin for the first-line treatment of patients with NSCLC and subgroup analysis of phase 3 data has suggested superior survival in older patients.

METHODS:

The authors conducted a phase 2 study of nab-paclitaxel in 42 patients aged ≥70 years who had been treated previously with a platinum doublet regimen; patients also could have received a PD-1 inhibitor. The primary endpoint of the current study was grade 3 to 5 toxicity (according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.0]). In addition to response rate, progression-free survival (PFS), and overall survival (OS), geriatric assessments also were performed before and during treatment, associations between baseline sarcopenia and outcomes were explored, and changes in T lymphocyte p16 before and during treatment were measured. The authors also performed a retrospective subgroup analysis of 19 older patients who were treated with nab-paclitaxel as part of a larger, randomized, phase 2 study; data were not combined.

RESULTS:

The rate of grade 3 to 5 toxicities was 33.7%. The most common grade 3 to 5 toxicities were decreased white blood cell count (11.9%), neutropenia (9.5%), and fatigue (11.9%). The response rate was 34.2% (2.6% complete response rate and 31.6% partial response rate). The median PFS was 5.2 months and the median OS was 9.3 months. Adverse prognostic factors were common: 42% of patients were frail and 39% of patients were prefrail, whereas 21% had an Eastern Cooperative Oncology Group performance status of 2 and 27% were sarcopenic. Only frailty was found to be predictive of inferior survival. A subgroup analysis of 19 older patients treated with nab-paclitaxel alone in a prior trial demonstrated a response rate of 15.8%, a PFS of 4.2 months, and an OS of 13.6 months.

CONCLUSIONS:

Fit and prefrail older patients with stage IV NSCLC should be considered for treatment with nab-paclitaxel after disease progression with doublet chemotherapy.

KEYWORDS:

elderly; geriatric assessment; lymphocyte p16; nanoparticle albumin-bound (nab)-paclitaxel; non-small cell lung cancer (NSCLC); sarcopenia

PMID:
31943168
DOI:
10.1002/cncr.32573

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