Less Neuropathy Observed with Nab- vs Solvent-Based Paclitaxel in Patients with NSCLC
WASHINGTON, DC—Data from the phase 3 study that led to the U.S. Food and Drug Administration October 2012 approval of nab-paclitaxel in combination with carboplatin for the first-line treatment of advanced non-small cell lung cancer (NSCLC) will help nurses prepare for side effects to ensure all are managed quickly and doses adjusted so patients can continue to receive appropriate therapy, a study reported at the Oncology Nursing Society (ONS) 38th Annual Congress.
The nursing implications of and management strategies for treating patients with the taxanes focuses primarily on neuropathy, noted Beth Eaby-Sandy, MSN, CRNP, OCN®, ofAbraham Cancer Center, University of Pennsylvania, Philadelphia, PA. Managing neuropathy “centers around delaying treatment, reducing taxane doses, lifestyle modifications, and medication management.”
The phase 3 trial compared weekly nab-paclitaxel 100 mg/m2 with solvent-based paclitaxel 200 mg/m2 administered every 3 weeks, both with carboplatin, in patients with advanced NSCLC. Weekly nab-paclitaxel significantly increased overall response rate vs solvent-based paclitaxel (33% vs 25%; P=0.005), and a trend was shown toward improved overall and progression-free survival (~10% longer median PFS and OS with nab-paclitaxel). Significantly less neuropathy, neutropenia, arthralgia, and myalgia were observed with nab-paclitaxel, while less thrombocytopenia and anemia were observed with solvent-based paclitaxel.
During the study, the most common grade 3/4 non-hematologic adverse events reported were fatigue, sensory neuropathy, anorexia, nausea, myalgia, and arthralgia. Grade 3/4 neuropathy rates were significantly lower in the nab-paclitaxel arm, 3%, vs 12% in the solvent-based paclitaxel arm (P=0.001).
The total score of all 16 questions on the patient-reported Functional Assessment of Cancer Therapy (FACT)-Taxane questionnaire—including neuropathy, pain in hands/feet, and hearing loss—significantly favored the nab-paclitaxel regimen. Time to improvement in grade 3/4 neuropathy to grade 1 was 38 days with nab-paclitaxel vs 104 days with solvent-based paclitaxel.
“FACT-Taxane is a comprehensive tool used to evaluate neuropathy by asking specific questions about the side effects of taxanes, including pain, numbness, and specific activities of daily living, such as buttoning a shirt,” Eaby-Sandy stated.
“Patient-reported outcomes such as this are important for assessing the impact of chemotherapy on patients' quality of life, and using tools such as this may allow healthcare providers to accurately assess neuropathy and act to mitigate severity.”