Expert Review of Anticancer Therapy Downloaded from informahealthcare.com by Virginia Commonwealth University on 03/13/15 For personal use only.
Drug Profile
nab-paclitaxel for the management of patients with advanced non-small-cell lung cancer Expert Rev. Anticancer Ther. 14(2), 129–141 (2014)
Vera Hirsh Royal Victoria Hospital and Montreal General Hospital, McGill University, Montreal, Quebec, Canada Tel.: +1 514 934 1934 [email protected]
The 130 nm albumin-bound form of paclitaxel, nab-paclitaxel (Abraxane), was recently approved by the US FDA for the first-line treatment of locally advanced or metastatic non-small-cell lung cancer (NSCLC) in combination with carboplatin in patients who are not candidates for curative surgery or radiation therapy. In a Phase III registrational trial, nab-paclitaxel plus carboplatin demonstrated a significantly improved overall response rate, the primary endpoint, and a trend toward improved survival compared with solvent-based paclitaxel plus carboplatin in patients with advanced NSCLC. Significantly less neutropenia, neuropathy, arthralgia, and myalgia were observed with the nab-paclitaxel regimen, but the solvent-based paclitaxel regimen produced less thrombocytopenia and anemia. The clinical experience with nab-paclitaxel to date and the role of this newly approved therapy in the management of NSCLC will be summarized in this article. KEYWORDS: elderly . histology . nab-paclitaxel . non-small-cell lung cancer . taxanes
Worldwide, cancer of the lung and bronchus is the number one cause of cancer-related death in males and the number two cause of death in females; the ratio of mortality to incidence is 0.86 [1,2]. The highest lung cancer incidence rates are observed in North America, central, eastern and southern Europe and eastern Asia [2]. In the USA, the 5-year relative survival for all patients with cancer of the lung or bronchus was estimated to be 16.6% between 2003 and 2009 [3]. Globally, 5-year survival rates are worse for patients with cancer of the lung, bronchus and trachea compared with most other sites [1]. Treatment of lung cancer depends on several factors including the type and stage of the cancer, molecular alterations and receptor status [4,5]. Lung cancer mainly comprises small cell lung cancer and non-small-cell lung cancer (NSCLC), with the latter representing approximately 85–90% of all lung cancers [6]. NSCLC is heterogeneous, consisting of squamous cell and nonsquamous subtypes [6]. Nonsquamous NSCLC includes adenocarcinoma, large cell carcinoma and carcinoma not otherwise specified [6]. Adenocarcinoma and www.expert-reviews.com
10.1586/14737140.2014.881719
squamous cell carcinoma make up approximately 40 and 30% of all NSCLC, respectively [6]. In the USA, most patients with NSCLC have distant/advanced disease at the time of diagnosis (~54%), and the 5-year survival for these patients is only 3.9% [3]. Moreover, the median age at diagnosis of lung cancer is 70 years in the USA, and the 5-year survival rate in patients >65 years of age is lower compared with those
Drug Profile
nab-paclitaxel for the management of patients with advanced non-small-cell lung cancer Expert Rev. Anticancer Ther. 14(2), 129–141 (2014)
Vera Hirsh Royal Victoria Hospital and Montreal General Hospital, McGill University, Montreal, Quebec, Canada Tel.: +1 514 934 1934 [email protected]
The 130 nm albumin-bound form of paclitaxel, nab-paclitaxel (Abraxane), was recently approved by the US FDA for the first-line treatment of locally advanced or metastatic non-small-cell lung cancer (NSCLC) in combination with carboplatin in patients who are not candidates for curative surgery or radiation therapy. In a Phase III registrational trial, nab-paclitaxel plus carboplatin demonstrated a significantly improved overall response rate, the primary endpoint, and a trend toward improved survival compared with solvent-based paclitaxel plus carboplatin in patients with advanced NSCLC. Significantly less neutropenia, neuropathy, arthralgia, and myalgia were observed with the nab-paclitaxel regimen, but the solvent-based paclitaxel regimen produced less thrombocytopenia and anemia. The clinical experience with nab-paclitaxel to date and the role of this newly approved therapy in the management of NSCLC will be summarized in this article. KEYWORDS: elderly . histology . nab-paclitaxel . non-small-cell lung cancer . taxanes
Worldwide, cancer of the lung and bronchus is the number one cause of cancer-related death in males and the number two cause of death in females; the ratio of mortality to incidence is 0.86 [1,2]. The highest lung cancer incidence rates are observed in North America, central, eastern and southern Europe and eastern Asia [2]. In the USA, the 5-year relative survival for all patients with cancer of the lung or bronchus was estimated to be 16.6% between 2003 and 2009 [3]. Globally, 5-year survival rates are worse for patients with cancer of the lung, bronchus and trachea compared with most other sites [1]. Treatment of lung cancer depends on several factors including the type and stage of the cancer, molecular alterations and receptor status [4,5]. Lung cancer mainly comprises small cell lung cancer and non-small-cell lung cancer (NSCLC), with the latter representing approximately 85–90% of all lung cancers [6]. NSCLC is heterogeneous, consisting of squamous cell and nonsquamous subtypes [6]. Nonsquamous NSCLC includes adenocarcinoma, large cell carcinoma and carcinoma not otherwise specified [6]. Adenocarcinoma and www.expert-reviews.com
10.1586/14737140.2014.881719
squamous cell carcinoma make up approximately 40 and 30% of all NSCLC, respectively [6]. In the USA, most patients with NSCLC have distant/advanced disease at the time of diagnosis (~54%), and the 5-year survival for these patients is only 3.9% [3]. Moreover, the median age at diagnosis of lung cancer is 70 years in the USA, and the 5-year survival rate in patients >65 years of age is lower compared with those
