Introduction: Exploration of Nab-Paclitaxel in NSCLC

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Moderator Corey J. Langer, MD, introduces a panel discussion focused on unmet needs and emerging strategies in the treatment of patients with lung cancer. The discussion includes expert perspective from D. Ross Camidge, MD, PhD, Ramaswamy Govindan, MD, Roy S. Herbst, MD, PhD, Alice T. Shaw, MD, PhD, Mark A. Socinski, MD, and H. Jack West, MD.

The FDA approved nab-paclitaxel (Abraxane) plus carboplatin for patients with untreated locally advanced or metastatic non-small cell lung cancer (NSCLC) in October 2012. This approval was based on an improvement in overall response rate (ORR) in the phase III CA031 trial that compared weekly nab-paclitaxel plus carboplatin with solvent-based (sb) paclitaxel plus carboplatin, explains Socinski.

In the study, the ORR with nab-paclitaxel was 33% versus 25% with sb-paclitaxel (P = .005). Additionally, the trial found that patients with squamous histology who received nab-paclitaxel experienced more than a doubling in response when compared with sb-paclitaxel (41% vs 24%; P<.001). This advantage provides a clear clinical niche where nab-paclitaxel is more effective, Socinski believes.

Secondary survival endpoints were assessed but did not yield statistically significant results, Socinski notes. The progression-free survival for nab-paclitaxel was 6.3 months compared with 5.8 months for those receiving sb-paclitaxel (P = .214). The median overall survival was 12.1 months for nab-paclitaxel and 11.2 months for sb-paclitaxel (HR = 0.922; P = .271).

In elderly patients, there was a significant difference in overall survival, explains Socinski. For patients over the age of 70, the median OS was 19.9 months with nab-paclitaxel compared with 10.4 months for sb-paclitaxel (HR = 0.583). For patients under 70, the median OS was 11.4 months compared with 11.3 months, for nab- and sb-paclitaxel, respectively. The dramatic advantage seen in elderly patients warrants confirmation in a separate study, Socinski believes.