Carboplatin, Nab-Paclitaxel Demonstrates Efficacy in Small Cell Lung Cancer

the Cancer Therapy Advisor take:

The current standard of therapy for extensive-stage small cell lung cancer (ES-SCLC) is the combination of platinum and etoposide; however, patients on this combination regimen suffer from significant myelosuppresion. 

Based on previous trials conducted on single-agent nanoparticle albumin-bound paclitaxel, nab-paclitaxel, for different advanced cancers, investigators hypothesized that the combination therapy of carboplatin and nab-paclitaxel would be better tolerated.

A noncomparative randomized trial was conducted, and the primary objective was to assess the objective response rate. The secondary objectives were progression-free survival, overall survival, and toxicity.

In the study, eligible patients must be diagnosed with ES-SCLC, have an Eastern Cooperative Oncology Group performance status ≤2, and no prior chemotherapy. Patients were then randomly assigned into either arm A (carboplatin area under the curve [AUC] of 6 on day 1 and nab-paclitaxel of 300 mg/m2 on day 1 every 3 weeks) or arm B (carboplatin AUC of 6 on day 1 and nab-paclitaxel 100 mg/m2 on days 1, 8, and 15 every 21 days).

Results showed that a significant number of patients in both arms required dose reductions and/or dose delays, and omission of weekly therapy. Due to the slow accrual, no assessment of efficacy could be made, and thus the trial was terminated early.

Overall, investigators found that the combination of carboplatin and nab-paclitaxel demonstrated activity in ES-SCLC, but required frequent dose modifications. Authors conclude that further prospective trials in disease-specific populations need to be conducted in order to determine the factors that contribute to the tolerability of treatments.