Can a nanoparticle-based paclitaxel be more effective than a standard-preparation paclitaxel in the treatment of advanced non-small cell lung cancer?

This trial compared the use of standard paclitaxel (SP; Taxol) versus a new nanoparticle micellar preparation of paclitaxel (NmP) as a first-line treatment for non-small cell lung cancer (NSCLC). The authors found that NmP had better effectiveness and safety in treating NSCLC than SP. 

NSCLC is the most common form of lung cancer. Treatment for NSCLC is usually chemotherapy, radiotherapy, and surgical removal of tumors. Despite this, NSCLC can be difficult to treat.

Platinum-based regimens remain the standard first line treatment for NSCLC. They remain part of standard treatment despite advances being made in therapeutic options. Paclitaxel and carboplatin (Paraplatin) are chemotherapy medications used in the treatment of NSCLC. Paclitaxel (P) has been made into a nanoparticle micellar (Nm; ultrafine particle) form. NmP has been shown to have a higher anti-tumor activity than standard paclitaxel (SP) in experimental studies. However, the effectiveness and safety of NmP compared to SP, both in combination with carboplatin in treating NSCLC have not been evaluated.

There were 454 patients with NSCLC in this study. Patients were randomly assigned to receive NmP (302 patients) or SP (152 patients). Both groups also received carboplatin. 

There was an overall response rate (ORR) of 50% of the NmP group. This was compared to 26% in the SP group. Patients with squamous-type NSCLC had an ORR of 59% in the NmP group compared to 37% in the SP group. Patients with non-squamous type NSCLC had an ORR of 44% in the NmP group compared to 19% in the SP group. 

The average length of time without disease progression was 6.4 months in the NmP group and 5.3 months in the SP group. NmP was associated with a 37% better chance of not having disease progression compared to SP. The overall survival was slightly higher with NmP (18 months) compared to SP (16.4 months).

There was a trend of a lower rate of serious side effects in the NmP group (19%) versus 26% in the SP group.

The authors found that patients with NSCLC showed a greater response and a good safety profile to NmP compared to SP. 

This trial was carried out in a Chinese population and so may not translate well to a global population. This trial was sponsored by Shanghai Yizhong Biotechnological co., LTD, the manufacturers of NmP.