The Efficacy and Safety of Albumin-Bound Paclitaxel Plus Carboplatin as Neoadjuvant Therapy for Potentially Resectable Lung Squamous Cell Carcinoma

A Real-World Retrospective Cohort Study

Wenjuan Jiang; Yuling Zhou; Liang Zeng; Yi Xiong; Li Liu; Chunhua Zhou; Haiyan Yang; Hui Guo; Fabrizio Minervini; Stefano Bongiolatti; Nong Yang; Yongchang Zhang; Min Tao

Disclosures

Transl Lung Cancer Res. 2022;11(4):647-655. 

In This Article

Abstract and Introduction

Abstract

Background:In early and locally advanced stage non-small-cell lung cancer (NSCLC), surgery is the cornerstone of curative-intent treatments. And the addition of neoadjuvant or adjuvant chemotherapy can prolong overall survival (OS), albumin-bound paclitaxel plus carboplatin (ab-PC) as neoadjuvant therapy (NAT) has showed favorable effect for resectable lung squamous cell carcinoma (LSCC) with IIIA. However, to date, no study has investigated the efficacy of ab-PC as neoadjuvant chemotherapy in potentially resectable LSCC with IIIA–IIIB. This study aimed to evaluate the efficacy and safety of the regimen in potentially resectable LSCC.

Methods: Enrolled patients with stage IIIA and IIIB potentially resectable LSCC treated with neoadjuvant albumin-bound paclitaxel (nab-P; 100 mg/m2, days 1, 8, and 15) and carboplatin (6 mg/mL/min, day 1) for two 21-day cycles at the Hunan Cancer Hospital between December 2017 and December 2019. The primary endpoint was the surgery conversion rate (SCR). Secondary endpoints included objective response rate (ORR), margin-free (R0) resection, major pathological response (mPR), and safety.

Results: In total, 49 patients were included in the study, with an overall response rate (ORR) of 67% (33/49). The SCR was 67% (33/49). Only 31 patients underwent surgery eventually, and R0 resection was achieved in 30 patients. Further, 4 (13%) and 11 (35%) of the 31 patients had a pathological complete response (pCR) and mPR, respectively. In total, 23 patients experienced treatment-related adverse events (TRAEs). The most common TRAE was liver disfunction (9 patients, 18%). Only 1 patient (2%) experienced a grade ≥3 TRAE of leukopenia. There were no treatment-related deaths or treatment discontinuations.

Conclusions: In this study, we found a high SCR (67%) and mPR (35%) after ab-PC treatment for stage IIIA and IIIB potentially resectable LSCC. ab-PC maybe considered a neoadjuvant chemotherapy option for potentially resectable LSCC patients.

Introduction

Lung cancer is considered the most common cause of cancer death.[1] Non-small cell lung cancer (NSCLC) accounts for nearly 85% of lung cancer cases.[2] Lung squamous cell carcinoma (LSCC) is a common subtype of NSCLC. It is estimated that there are over 400,000 new LSCC cases worldwide each year.[3] Chemotherapy, radiotherapy, or surgery are common treatments for LSCC. Stage III NSCLC patients are highly heterogeneous and commonly need individual treatment. The patients with stage III can be classified into operable, potentially operable, and inoperable according to the mass size, location, and lymph node. Although surgery is a curative method, only surgery is typically recommended for stage III patients due to high proportion of local recurrence and distant metastases.[4,5] For potentially resectable patients, interdisciplinary multimodality management was usually performed and lack of standard therapy.

Neoadjuvant therapy (NAT) is defined as either chemotherapy or radiation administered before surgery, and can downstage tumors and prolong the survival of lung cancer patients with resection.[6,7] It may imply that NAT can transform lung cancer patients from potentially resectable to resectable, similarly. Albumin-bound paclitaxel (ab-P), which is a novel solvent-free nanomedicine of taxane, has a favorable tumor-specific killing effect and exhibits minimal toxicity to normal tissues.[8] In LSCC patients, ab-P plus platinum is recommend as the first-line treatment and has excellent anti-tumor activity.[9,10] Therefore, for stage IIIA and IIIB potentially resectable LSCC, ab-P plus platinum as NAT may be a potentially treatment. However, studies on neoadjuvant ab-P plus carboplatin (nab-PC) as a type of NAT are limited, and the response of potentially resectable LSCC patients to nab-PC is still unknown. We conducted a retrospective study to examine the efficacy and safety of nab-PC in locally advanced potentially resectable LSCC patients. We present the following article in accordance with the STROBE reporting checklist (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-22-252/rc).

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