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Nab-paclitaxel in older patients with non-small cell lung cancer who have developed disease progression after platinum-based doublet chemotherapy.
- Source :
-
Cancer (0008543X) . Mar2020, Vol. 126 Issue 5, p1060-1067. 8p. - Publication Year :
- 2020
-
Abstract
- <bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>Fit and prefrail older patients with stage IV NSCLC should be considered for treatment with nab-paclitaxel after disease progression with doublet chemotherapy. [ABSTRACT FROM AUTHOR]
- Subjects :
- *NON-small-cell lung carcinoma
*OLDER patients
*LEUKOCYTE count
*DISEASE progression
*PATIENT selection
*ALBUMINS
*LUNG cancer
*RESEARCH
*CLINICAL trials
*RESEARCH methodology
*LUNG tumors
*RETROSPECTIVE studies
*PROGNOSIS
*EVALUATION research
*MEDICAL cooperation
*PLATINUM
*COMPARATIVE studies
*RESEARCH funding
*SALVAGE therapy
*PACLITAXEL
*DRUG resistance in cancer cells
*SQUAMOUS cell carcinoma
*LONGITUDINAL method
Subjects
Details
- Language :
- English
- ISSN :
- 0008543X
- Volume :
- 126
- Issue :
- 5
- Database :
- Academic Search Index
- Journal :
- Cancer (0008543X)
- Publication Type :
- Academic Journal
- Accession number :
- 141719780
- Full Text :
- https://doi.org/10.1002/cncr.32573