The association between diabetes and clinical outcomes in patients with advanced non–small-cell lung cancer (NSCLC) is unclear. Therapy with nab-paclitaxel plus carboplatin (nab-P/C) improved the primary end point (overall response rate) versus solvent-based paclitaxel plus carboplatin (sb-P/C) in the overall population and in a subset of patients with diabetes in a phase 3 trial of advanced NSCLC. Rate of neuropathy was lower with nab-P/C versus sb-P/C. nab-P/C is preferable for patients with NSCLC and diabetes.Purpose:
To examine outcomes in a phase 3 trial of nab-paclitaxel plus carboplatin (nab-P/C) versus solvent-based paclitaxel plus carboplatin (sb-P/C) in a subset of patients with advanced non–small-cell lung cancer (NSCLC) and diabetes.Patients and Methods:
Patients with stage IIIB/IV NSCLC received nab-P 100 mg/m2 on days 1, 8, and 15 or sb-P 200 mg/m2 on day 1, both with C at an area under the curve of 6 mg·min/mL on day 1 every 3 weeks. Overall response rate (ORR) and progression-free survival (PFS) were determined by blinded, independent, centralized review. P values were based on chi-square test for ORR and log-rank test for overall survival (OS) and PFS.Results:
Of the 1052 randomized patients in the phase 3 trial, 61 had diabetes according to prespecified terms (nab-P/C, 31; sb-P/C, 30). ORR for nab-P/C versus sb-P/C in this subset was 52% versus 27% (relative risk ratio, 1.935; P = .046), median PFS was 10.9 versus 4.9 months (hazard ratio, 0.420; P = .016), and median OS was 17.5 versus 11.1 months (hazard ratio, 0.550; P = .057). Treatment differences in PFS remained significant (P ≤ .036) after adjusting for histology, region, stage, race, and age and also remained significant in OS for histology (P = .039). Patients with diabetes experienced lower rates of grade 3 or higher neutropenia and peripheral neuropathy and higher rates of thrombocytopenia and anemia with nab-P/C versus sb-P/C.Conclusion:
nab-P/C demonstrated improved efficacy and manageable tolerability in patients with advanced NSCLC and diabetes.