Efficacy and safety of metronomic administration of paclitaxel for advanced recurrent non-small-cell lung cancer.
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Date
2013-04
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Abstract
CONTEXT: There are limited effective therapeutic options in the relapsed setting for non-small cell lung cancer (NSCLC)
or in the first line for platinum‑ineligible patients. AIM: To evaluate the safety and efficacy of a metronomic schedule
of paclitaxel administered weekly in relapsed refractory NSCLC or upfront in patients not eligible for platinum‑based
chemotherapy. SETTINGS AND DESIGN: Retrospective analysis of a prospectively collected database from the medical
oncology department at Tata Memorial Hospital in Mumbai, India. MATERIALS AND METHODS: Patients with recurrent
and treatment-naïve platinum-ineligible advanced NSCLC were treated with weekly paclitaxel at 80 mg/m2 with palliative
intent. Restaging scans were obtained every two months. Chemotherapy was continued until progressive disease, intolerable
side effects, or decision of the patient. STATISTICAL ANALYSIS USED: SPSS version 16 was used for analysis. Simple
percentages were used for descriptive statistics. Progression‑free survival (PFS) was calculated from date of start of paclitaxel
till the date of progression, change of therapy due to any reason, or death due to any cause. Overall survival (OS) was
calculated from date of start of paclitaxel to death. The Kaplan Meier method was used for estimation of survival. RESULTS:
There were 37 patients over eight months. The median age was 59 years, with a male‑to‑female ratio of 5:1. Two patients
received paclitaxel in the first line, 18 patients in second line, nine in third line, five in fourth line, and three were in fifth
line. 73% patients had received prior platinum and 48.6% patients had Eastern Cooperative Oncology Group performance
status (ECOG PS) >2. The median number of weekly cycles delivered was 14. The response rate was 35% [complete
remission (CR): 2.7%, partial remission (PR): 32.4%, stable disease (SD): 32.4%, progressive disease (PD): 27%], the
median PFS was four months, and the estimated median OS was seven months. Chemotherapy was well tolerated. The
most frequent grade 3 toxicities included anemia: 8%, neutropenia: 5.4%, and sensory neuropathy: 8%. There were no
grade 4 toxicities and no episodes of febrile neutropenia. CONCLUSIONS: Weekly low‑dose continuous metronomic‑type
scheduling of paclitaxel is safe and effective for relapsed refractory NSCLC and in the first line in platinum-ineligible patients.
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Keywords
Lung cancer, metronomic, non‑small‑cell lung carcinoma, refractory, relapsed, second line, non-small cell lung cancer
Citation
Noronha V, Patil V M, Joshi A, Prabhash K. Efficacy and safety of metronomic administration of paclitaxel for advanced recurrent non-small-cell lung cancer. Indian Journal of Cancer. 2013 Apr-June; 50(2): 122-127.