Chemotherapy outcomes depending on cancer type

This clinical trial compared the efficacy and safety of a combined chemotherapy regimen of nab-paclitaxel (Abraxane) plus carboplatin (Paraplatin) versus solvent-based paclitaxel (Taxol) plus carboplatin in patients with advanced non-small-cell lung cancer (NSCLC) basing on the microscopic appearance of the cancer tissue (histology).

Non-small-cell lung cancer (NSCLC) is the most common type of lung cancer. There are three subtypes of NSCLC: squamous cell carcinoma (SCC) starts in the squamous cells (the cells that line the inner airways of the lungs) and develops in the central regions of the lungs, adenocarcinoma, which is more frequent in non-smokers and develops in the outer regions of the lungs in cells that produce mucus, and large cell carcinoma (LCC), which can be found anywhere in the lung and grows more quickly than the other types of NSCLC. Adenocarcinoma and LCC are classified together as non-squamous cell carcinoma (NSCC). 

Chemotherapy is the most commonly used treatment for patients with advanced NSCLC and the choice of chemotherapy drugs depends on the type of cancer. Carboplatin (C) is a chemotherapy drug that damages the DNA (the cells' genetic material) of rapidly growing cells, thus causing the death of cancer cells. Nab-paclitaxel (nab-P), is a microtubule inhibitor (targets cellular components responsible for maintaining the structure of the cell and for cell division), thus stopping the growth of the cancer cells. Solvent-based paclitaxel (sb-P) is a mitotic inhibitor which prevents division of cancer cells. The present study aimed to evaluate the outcomes of patients with NSCLC treated with C combined with nab-P or sb-P, based on the type of cancer.

This trial enrolled 1052 patients with advanced NSCLC. According to histology, 450 patients had SCC while 602 patients had NSCC. Patients were randomly assigned to receive either weekly nab-P plus C every 3 weeks (229 SCC patients and 292 NSCC patients) or sb-P plus C every 3 weeks (221 SCC patients and 310 NSCC patients). The main parameters evaluated were overall response rate or ORR (defined as the percentage of patients whose cancer shrinked or disappeared after treatment) and overall survival or OS (defined as the time patients survived with or without the cancer after treatment). 

After approximately 18 months of follow-up, patients with SCC treated with nab-P plus C had a 41% ORR versus 24% in those treated with sb-P and C, while the ORR in NSCC patients was 26% with nab-P/C and 25% with sb-P/C. Median OS for the SCC group was 10.7 months versus 9.5 months with nab-P/C versus sb-P/C, respectively, while for the NSCC OS was 13.1 months versus 13 months, respectively. In the safety analysis, nab-P/C was associated with a lower level of peripheral nerve damage and joint pain than sb-P/C while sb-P/C produced less thrombocytopenia (decrease of platelets in the blood) and anemia (decrease in the number of red blood cells) than nab-P/C.

In summary, treatment with nab-P/C of patients with advanced NSCLC demonstrated a more favorable risks and benefits profile compared to sb-P/C, regardless of histology.

The study was funded by Celgene Corporation, the manufacturer of Abraxane.

Consult your physician on the most appropriate treatment in your situation.