Switching From Docetaxel to Paclitaxel and Bevacizumab Improves PFS in NSCLC
Patients with non-squamous non-small cell lung cancer (NSCLC) have improved progression-free survival (PFS) if they switch from docetaxel to paclitaxel and bevacizumab treatments, according to new research.
Docetaxel is a standard 2nd- or 3rd-line treatment for lung cancer. Its effectiveness has been validated in numerous clinical trials, but the adverse events and toxicities associated with it are difficult to manage.
Bevacizumab is an antiangiogenic treatment validated in numerous breast cancer trials in combination with paclitaxel. Patients with breast cancer who use paclitaxel and bevacizumab have had their response rates and progression-free survival doubled, although a combination of the two therapies had yet to be researched in patients with lung cancer.
In two retrospective, phase III studies comparing the efficacy of paclitaxel and bevacizumab versus docetaxel in second- or third-line treatment of non-squamous NSCLS, 166 patients with non-squamous NSCLC were given the option of crossing over from a study arm in which they received weekly docetaxel (75 mg/m2 IV on day one of a 21-day cycle) to a study arm in which they received weekly paclitaxel and bevacizumab (90 mg/m2 IV on days 1,8, and 15 of a 28-day cycle; 10 mg/kg on day 1 and 15 of a 28-day cycle, respectively), or vice versa, at progression. Patients who did not cross over received a post-discontinuation treatment within 60 days of progression. PFS was calculated starting on day-1 of post-discontinuation treatment.
Clinically significant improvements in PFS were observed for patients treated with paclitaxel and bevacizumab. Patients who crossed over to paclitaxel and bevacizumab (21 of the 55 patients) had a 4.9-month median PFS (range, 3.1-6.2 months) post-discontinuation. In contrast, patients who crossed over to docetaxel (9 of the 111 patients) had a 1.9-month median PFS (range, 1.2-2.2 months) post-discontinuation. Patients receiving post-discontinuation paclitaxel and bevacizumab treatment who did not cross over had a 1.9-month median (1.7-2.6) PFS, and patients receiving post-discontinuation docetaxel treatment who did not cross over had a 1.7-month median PFS (range, 1.1-2.2 months).
Researchers suggest that crossing over from docetaxel to paclitaxel and bevacizumab at progression is the most beneficial course of treatment for improved PFS. Data were presented at the International Association for the Study of Lung Cancer (IASLC) 17TH Annual World Conference (December 4-7; Vienna, Austria).
Further research and trials are necessary to validate this treatment course for patients with non-squamous NSCLC.