Safety and efficacy of weekly nab®-paclitaxel in combination with carboplatin as first-line therapy in elderly patients with advanced non-small-cell lung cancer

Socinski, Mark A.; Langer, Corey J.; Okamoto, Isamu; Hon, Jeremy K.; Hirsh, Vera; Dakhil, Shaker R.; Page, Ray D.; Orsini, James; Zhang, H.; Renschler, Markus F.

doi:10.1093/annonc/mds461

Cited by 99 publications

(104 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Finally, among elderly patients in the aforementioned phase iii trial, a greater percentage receiving nab-paclitaxel-carboplatin than receiving sbpaclitaxel-carboplatin went on to receive secondline therapy, which has been demonstrated to improve survival over best supportive care or placebo 63,81,82 . Further studies are warranted to determine the reasons for the improved os demonstrated by nab-paclitaxel-carboplatin in elderly patients.…”

Section: Taxanes In the Elderlymentioning

confidence: 99%

Update on Taxanes in the First-Line Treatment of Advanced Non-Small-Cell Lung Cancer

Socinski¹

2014

Current Oncology

Self Cite

View full text Add to dashboard Cite

standard-of-care options, and no single standardof-care regimen is superior in the treatment of advanced nsclc 7-10 . Thus, physicians rely on numerous factors to optimize treatment strategies, including histology, age, performance status, cost, tolerability, and convenience. The combination of a platinum agent with a taxane-either solvent-based (sb) paclitaxel (Taxol: Bristol-Myers Squibb, Princeton, NJ, U.S.A.) or docetaxel (Taxotere: SanofiAventis, Bridgewater, NJ, U.S.A.)-has a proven efficacy and safety profile in advanced nsclc 6 . The sb-paclitaxel-carboplatin regimen is among those most commonly used for the first-line treatment of advanced nsclc in the United States 11 .Recently, nab-paclitaxel, a 130-nm albuminbound ("nab") form of paclitaxel designed to use endogenous albumin pathways to increase intratumoural concentrations of the active drug, demonstrated improved antitumour activity and tolerability compared with sb-paclitaxel when both were used in combination with carboplatin in the first-line treatment of patients with advanced nsclc 12 . Based on the results of a phase iii trial, nab-paclitaxel in combination with carboplatin was approved in 2012 as first-line therapy for the treatment of locally advanced or metastatic nsclc in patients who are not candidates for curative surgery or radiation therapy 12,13 . The present review summarizes the clinical experience to date with taxanes in the first-line treatment of nsclc. DISCUSSION Taxane-Platinum CombinationsIn landmark nsclc studies, overall response rates (orrs) were higher with taxane-platinum combinations than with other chemotherapy regimens ( Table i). Historically, sb-paclitaxel given in combination with carboplatin or cisplatin demonstrated a median overall survival (os) of 7.7-10 months and an orr of 17%-41% [7][8][9]11,14,[16][17][18]22 . ABSTRACTBased on demonstrated favourable risk-benefit profiles, taxanes remain a key component in the first-line standard of care for advanced non-smallcell lung cancer (nsclc) and nsclc subtypes. In 2012, a novel taxane, nab-paclitaxel (Abraxane: Celgene Corporation, Summit, NJ, U.S.A.), was approved, in combination with carboplatin, for the first-line treatment of locally advanced or metastatic nsclc. The approval was granted because of demonstrated improved antitumour activity and tolerability compared with solvent-based paclitaxelcarboplatin in a phase iii trial. This review focuses on the evolution of first-line taxane therapy for advanced nsclc and the new options and advances in taxane therapy that might address unmet needs in advanced nsclc.

show abstract

Section: Taxanes In the Elderlymentioning

confidence: 99%

Update on Taxanes in the First-Line Treatment of Advanced Non-Small-Cell Lung Cancer

Socinski¹

2014

Current Oncology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Interestingly, patients .70 years old (n=156) showed a significantly longer OS with nab-paclitaxel versus sb-paclitaxel (19.9 versus 10.4 months, respectively; P,0.009). 70,72 OS was largely similar between the two groups at different centers where this clinical trial was conducted, except for a significant difference noticed in North America. Patients from North America had improved OS when treated with nab-paclitaxel versus sb-paclitaxel (12.7 versus 9.8 months, respectively; P=0.008).…”

Section: Phase III Studymentioning

confidence: 69%

First line treatment of advanced non-small-cell lung cancer – specific focus on albumin bound paclitaxel

Gupta¹,

Hatoum²,

Dy³

2013

IJN

View full text Add to dashboard Cite

Lung cancer is the leading cause of cancer mortality worldwide in both men and women. Non-small-cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for more than 80% of cases. Paclitaxel has a broad spectrum of activity against various malignancies, including NSCLC. Paclitaxel is poorly soluble in water and thus, until recently, its commercially available preparations contained a non-ionic solvent Cremophor EL®. Cremophor EL® improves the solubility of paclitaxel and allows its intravenous administration. However, certain side-effects associated with paclitaxel, such as hypersensitivity reactions, myelosuppression, and peripheral neuropathy, are known to be worsened by Cremophor®. Nanoparticle albumin-bound paclitaxel ([nab-paclitaxel] ABRAXANE® ABI-007) is a new generation formulation of paclitaxel that obviates the need for Cremophor®, resulting in a safer and faster infusion without requiring the use of premedications to avoid hypersensitivity. Albumin-binding receptor-mediated delivery and lack of sequestering Cremophor® micelles allow higher intratumoral concentration of pharmacologically active paclitaxel. Multiple clinical trials have demonstrated a superior tolerability profile of nab-paclitaxel in comparison to solvent-bound paclitaxel (sb-paclitaxel). A recent Phase III trial compared the effects of weekly nab-paclitaxel in combination with carboplatin versus sb-paclitaxel in combination with carboplatin given every 3 weeks for first line treatment of NSCLC. This trial highlights the weekly nab-paclitaxel combination as an alternate treatment option for NSCLC, with higher response rate in squamous cell NSCLC and longer survival in elderly patients. This review will focus on the properties of nab-paclitaxel and its use in the first line treatment of NSCLC.

show abstract

“…This regimen showed a significant improvement in overall survival of 19.4 months compared with 10.4 months in the Taxol/carboplatin arm (HR: 0.583) [28] in the >70-year age group. This study also showed an improvement in PFS (median: 8.0 vs 6.8 months, HR: 0.687; p = 0.134).…”

Section: For Reprint Orders Please Contact: Reprints@futuremedicinecommentioning

confidence: 93%

Non-Small-Cell Lung Cancer in the Elderly With An Emphasis On Chemotherapy In The Adjuvant And Metastatic Disease Settings

Menon

Jatoi

2014

Lung Cancer Manag.

View full text Add to dashboard Cite

SUMMARY Most lung cancer patients in the USA are older than 65 years of age, and yet oncologists continue to struggle with how best to treat these older patients. This article reviews the medical management of non-small-cell lung cancer in older patients with a focus on decision-making with respect to chemotherapy in the adjuvant setting and metastatic disease settings. In these two settings, chemotherapy as a single-modality intervention can provide a major positive impact. Nonetheless, a relative dearth of evidence in these settings underscores the need to summarize the available data in an effort to make patient counseling easier for healthcare providers and to make decision-making easier for patients and their families.Lung cancer is a disease of the elderly. Previous studies show that 47% of lung cancer patients are 70 years of age or older [1]. In this setting, decreased organ function with reduced clearance of chemotherapy and poor bone marrow reserve can cause high rates of severe adverse events. For example, myelosuppression is a frequently reported adverse event in older cancer patients, and it can be severe. Thus, older patients, who represent a substantial proportion of all lung cancer patients, often require greater time and effort in the clinic, as oncology healthcare providers advise these patients about the role of chemotherapy in the management of their disease.A major challenge medical oncologists face is determining whether or not to prescribe chemotherapy to older cancer patients, and, if so, how. Enrollment of older patients to cancer clinical trials has been comparatively limited [2], thus raising concerns that conclusions from such trials may not Practice points• A large proportion of lung cancer patients are 70 years of age or older.• The limited participation of elderly patients in prospective clinical trials lessens our ability to make robust conclusions.• There is a need for better tools for comprehensive assessments in older patients in order to better predict how well they will tolerate chemotherapy.• Subset analyses suggest some older patients may benefit from adjuvant chemotherapy. However, there is sparse evidence to support adjuvant chemotherapy in patients who are 80 years of age or older.• In patients with metastatic lung cancer, evidence supports that chemotherapy can prolong life and improve symptoms.• Combination chemotherapy may be feasible in a subset of older non-small-cell lung cancer patients.• There is controversy regarding the benefit of bevacizumab in older non-small-cell lung cancer patients.For reprint orders, please contact: reprints@futuremedicine.com

show abstract

Safety and efficacy of weekly nab®-paclitaxel in combination with carboplatin as first-line therapy in elderly patients with advanced non-small-cell lung cancer

Abstract: In elderly NSCLC patients, nab-P/C as first-line therapy was well tolerated and improved the ORR and PFS, with substantially longer OS versus sb-PC.

Cited by 99 publications

References 24 publications

Update on Taxanes in the First-Line Treatment of Advanced Non-Small-Cell Lung Cancer

Update on Taxanes in the First-Line Treatment of Advanced Non-Small-Cell Lung Cancer

First line treatment of advanced non-small-cell lung cancer – specific focus on albumin bound paclitaxel

Non-Small-Cell Lung Cancer in the Elderly With An Emphasis On Chemotherapy In The Adjuvant And Metastatic Disease Settings

Contact Info

Product

Resources

About

Safety and efficacy of weekly nab®-paclitaxel in combination with carboplatin as first-line therapy in elderly patients with advanced non-small-cell lung cancer

Abstract: In elderly NSCLC patients, nab-P/C as first-line therapy was well tolerated and improved the ORR and PFS, with substantially longer OS versus sb-PC.

Cited by 99 publications

References 24 publications

Update on Taxanes in the First-Line Treatment of Advanced Non-Small-Cell Lung Cancer

Update on Taxanes in the First-Line Treatment of Advanced Non-Small-Cell Lung Cancer

First line treatment of advanced non-small-cell lung cancer &ndash; specific focus on albumin bound paclitaxel

Non-Small-Cell Lung Cancer in the Elderly With An Emphasis On Chemotherapy In The Adjuvant And Metastatic Disease Settings

Contact Info

Product

Resources

About

First line treatment of advanced non-small-cell lung cancer – specific focus on albumin bound paclitaxel