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

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.

Keywords: Potentially resectable lung squamous cell carcinoma (potentially resectable LSCC); carboplatin; neoadjuvant albumin-bound paclitaxel (nab-P); neoadjuvant chemotherapy; pathological response.

Figure 1

The diagram of this study.

Figure 2

The clinical and pathological assessment of response to NAT. (A,B) Waterfall plots of radiographic percentage changes in overall (n=49) or surgical population (n=31) tumor size from the baseline after 2-cycle of NAT with nab-PC. The dashed black line at the 20%-point depicts the cutoff for PD. The dashed black line at the −30%-point depicts the cutoff for PR. (C) The proportion of mPR/no mPR (≤10% viable tumor/>10% viable tumor) and pCR/no pCR (0% viable tumor/>0% viable tumor) in resected patients after neoadjuvant nab-PC. (D) The correlation between the radiographic response and the pathologic response. The two-sided P value from Pearson correlation coefficient analysis. CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease; mPR, major pathological response; NAT, neoadjuvant therapy; nab-PC, neoadjuvant albumin-bound paclitaxel plus carboplatin; pCR, pathological complete response.

Figure 3

Special case report: pathological images and radiological evaluation of the resected patient before and after 2-cycle of nab-PC combination therapy. (A) The diagnostic (left) and resected (right) tissue of HE staining of patient [bars: 25 µm (10×10)]; (B) the radiological evaluation before (left) and after (right) neoadjuvant treatment. The red arrows show the mass. nab-PC, neoadjuvant albuminbound paclitaxel plus carboplatin; HE, hematoxylin-eosin.