Nab-paclitaxel/carboplatin Induction in Squamous NSCLC: Longitudinal Quality of Life While on Chemotherapy

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Four cycles of nab-paclitaxel plus carboplatin may improve the quality of life (QoL) of patients with squamous non-small cell lung cancer (NSCLC), particularly among responders compared with nonresponders, results of this study have shown.

Although there are many treatment options for patients with advanced NSCLC (eg, chemotherapy, immune-targeting therapies), evidence for whether treatments improve the QoL of patients over time is inconclusive.

For this study, 206 lesion-response-evaluable patients received 4 cycles of nab-paclitaxel plus carboplatin, and had their QoL measured by the Lung Cancer Symptom Scale (LCSS) and Euro-QoL Dimensions-5 (EQ-5D-5L) at baseline and on day 1 of each chemotherapy cycle.

Study patients experienced continual improvements in LCSS total score and symptom burden index from baseline to each cycle, and patients who had a tumor response to therapy generally had higher scores compared with patients whose tumors did not respond. 

Lung Cancer: Targets and Therapy
Lung Cancer: Targets and Therapy

Background: Longitudinal data on the impact of treatment on quality of life (QoL) in advanced non-small cell lung cancer (NSCLC) are limited. In this palliative setting, treatment that does not deteriorate QoL is key. Here we report longitudinal QoL in patients with squamous NSCLC, receiving ≤4 cycles of nab-paclitaxel/carboplatin combination chemotherapy.
Methods: Patients received nab-paclitaxel 100 mg/m2 days 1, 8, 15 + carboplatin area under the curve 6 mg•min/mL day 1 (q3w) for four cycles. QoL was assessed by the Lung Cancer Symptom Scale (LCSS) and Euro-QoL-5 Dimensions-5 Levels (EQ-5D-5L) at baseline and each cycle (day 1). 
Results: Two-hundred and six lesion-response-evaluable patients completed baseline + ≥1 postbaseline QoL assessment and were QoL evaluable. LCSS average total score and symptom burden index improved from baseline throughout four cycles. In the LCSS pulmonary symptoms score, 46% of patients reported clinically meaningful improvement (≥10 mm visual analog scale) from baseline. Individual EQ-5D-5L dimensions remained stable/improved in ≥83% of patients; ≈33% reported complete resolution of baseline problems at least once during four cycles. Generally, responders (unconfirmed complete/partial response) had higher scores vs nonresponders.
Conclusion: In patients with squamous NSCLC, four cycles of nab-paclitaxel/carboplatin demonstrated clinically meaningful QoL improvements, with greater benefits in responders vs nonresponders. 


Keywords: nab-paclitaxel, non-small cell lung cancer, quality of life, response, squamous 

INTRODUCTION

Patients with advanced non-small cell lung cancer (NSCLC) often experience a high symptom burden and a significantly deteriorated quality of life (QoL).1–3 In a real-world cross-sectional analysis of patients receiving treatment for advanced NSCLC (N = 450), all patients reported experiencing fatigue, and most experienced loss of appetite, shortness of breath, cough, hemoptysis, and pain.4 These data indicate that in addition to prolonging survival, identifying a first-line treatment regimen that does not deteriorate physical well-being but instead maintains or improves symptom burden and/or QoL, is important for disease and treatment outcomes. 

Despite recent treatment advances, chemotherapy remains the first-line standard of care for the majority of patients with advanced NSCLC (without a high level of PD-L1 expression), including those with squamous histology.5,6 However, there is a paucity of longitudinal QoL data from patients with advanced NSCLC receiving chemotherapy, and the data that do exist are often contradictory. Some studies have found that platinum-based chemotherapy improves QoL,7 while others have found no improvement in QoL when compared with other treatments such as targeted agents.8–10 Prospective QoL data from clinical trials are even more limited in patients with squamous NSCLC, as few trials have reported QoL outcomes by histology.

nab-Paclitaxel in combination with carboplatin is approved for the first-line treatment of locally advanced or metastatic NSCLC in patients who are not candidates for curative surgery or radiation therapy, based on a favorable risk-benefit profile compared with paclitaxel plus carboplatin in a randomized Phase III trial.11,12 Compared with paclitaxel plus carboplatin, nab-paclitaxel plus carboplatin demonstrated a significant increase in the primary endpoint of overall response rate (ORR) (33% vs 25%, P = 0.005) in the intent-to-treat population. A subset analysis of patients with squamous histology demonstrated a 68% improvement in ORR with nab-paclitaxel plus carboplatin compared with paclitaxel plus carboplatin (41% vs 24%; P < 0.001).12 The nab-paclitaxel plus carboplatin regimen was also well tolerated across histologies, as evidenced by the safety profile and patient-reported taxane-related symptom improvements.12–14 Although significant reductions in taxane-related symptoms such as neuropathy and neuropathic pain were reported with nab-paclitaxel plus carboplatin compared with paclitaxel plus carboplatin, it should be noted that improvements in these taxane-related symptoms may not reflect improvements in overall patient QoL.14 This further underscores the need to assess the impact of this regimen on QoL in a prospective clinical trial.

The Phase III ABOUND.sqm trial is investigating first-line nab-paclitaxel plus carboplatin treatment followed by nab-paclitaxel with or without best supportive care as maintenance treatment in patients with advanced squamous NSCLC. The objective of this analysis was to evaluate the impact of four cycles of nab-paclitaxel plus carboplatin on patient-reported symptoms and health-related QoL outcomes. 

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