An open-label, phase II trial of nanoparticle albumin bound paclitaxel (nab-paclitaxel), carboplatin, and bevacizumab in first-line patients with advanced non-squamous non-small cell lung cancer (NSCLC)

7610

Background: The development of nab-paclitaxel has circumvented many of the infusion difficulties that are associated with standard solvent based paclitaxel (in cremophor). In this open label, phase II trial, patients with advanced (stage IIIB or IV) nonsquamous NSCLC received the combination of nab-paclitaxel, carboplatin and bevacizumab. Methods: 50 patients were enrolled between October 2005 and April 2006. Patients received intravenous (IV) nab-paclitaxel 300 mg/m2, carboplatin IV AUC=6, and bevacizumab 15 mg/kg on day 1 of each 21-day cycle. Responding patients received at least 4 cycles of treatment; however, therapy was discontinued for patients with progression or intolerable toxicity. The primary endpoint was response rate based on RECIST. Results: The median patient age was 67 years; 80% were white and 56% were female. Patients received a median of 4 cycles (range, <1–6). The preliminary efficacy results are PR 30% and SD 48%; no complete responses were noted. Median progression-free survival was 7.1 months (range, <1–10.6); median survival has not yet been reached. Grade 3–4 treatment related toxicities were neutropenia (52%); fatigue (19%); neuropathy (15%); thrombocytopenia (10%) dyspnea (6%), anorexia, constipation, febrile neutropenia, hemoptysis, and nausea and/or vomiting (4% each). 64% of patients are currently alive. 32 patients have come off study, prior to 4 cycles due to disease progression (12%), adverse event (10%), investigator request (8%), sudden death (6%), and withdrawal of consent (2%); 16 patients had normal study completion (completed 4 cycles of therapy). Conclusions: This combination of nab-paclitaxel, carboplatin and bevacizumab was well tolerated, with moderate neutropenia. Adverse events were manageable. The preliminary analysis from this study indicates that this combination has promising activity in first-line patients with non-squamous NSCLC. This research was supported, in part, by a research grant from Abraxis BioScience, Inc., Santa Monica, CA.

No significant financial relationships to disclose.

Chemotherapy for metastatic non-small cell bronchogenic carcinoma: cyclophosphamide, doxorubicin, and etoposide versus mitomycin and vinblastine (EST 2575, generation IV)

Between March and December 1979, the Eastern Cooperative Oncology Group (ECOG) compared the CAVP16 (cyclophosphamide, doxorubicin, and etoposide) and MV (mitomycin and vinblastine) regimens in 200 patients with metastatic non-small cell bronchogenic carcinoma. Most patients were ambulatory (ECOG performance status, 0, 1; 75%) and had not received prior radiation therapy (76%). The CAVP16 regimen resulted in one complete and 13 partial responses (14%) and the mitomycin and vinblastine regimen resulted in two complete and 11 partial responses (13%). These results did not differ significantly (P = 0.45) nor did the results for median survival, 18 weeks for each regimen. Good performance status and prior surgical resection were positive predictors of improved survival. Toxicity was significant with eight drug-related deaths, six due to leukopenia and infection and one each due to renal failure and interstitial pneumonitis. CAVP16 resulted in significantly more serious and life-threatening toxicity (P less than 0.0001). Neither regimen is recommended for further study.