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Shuntaro Tokunaga



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    P2.17 - Treatment of Early Stage/Localized Disease (ID 189)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.17-05 - Feasibility Study of Adjuvant Chemotherapy with Carboplatin and Nab-Paclitaxel for Completely Resected NSCLC (ID 421)

      10:15 - 18:15  |  Author(s): Shuntaro Tokunaga

      • Abstract
      • Slides

      Background

      Cisplatin-based regimen is the standard adjuvant chemotherapy for patients with completely resected stage II or III non-small cell lung cancer (NSCLC). However, the patients unfit for cisplatin-based chemotherapy due to old age or renal impairment recently increased. This phase II study was conducted to evaluate the tolerability and efficacy of carboplatin and nab-paclitaxel as adjuvant chemotherapy.

      Method

      Patients with completely resected stage II to IIIA NSCLC enrolled. Eligible patients received postoperative adjuvant chemotherapy with 4 cycles carboplatin (area under the curve=5, on day1) and nab-paclitaxel (100 mg/m2, on days 1, 8 and 15) administered every 4 weeks. The primary endpoint was to evaluate the completion rate of 4 cycles of chemotherapy. We assumed completion rate of 50% would be the lower limit.

      Result

      From Jan 1, 2014 to Jan 31, 2019, 21 patients were enrolled, but two patients were excluded. Two patients of them are on protocol chemotherapy at data cutoff point. Median age of the 17 patients was 73 years (ranging from 53 to 80 years). Four of 17 patients (23.5%) were at stage IIA, 3 (17.6%) were at stage IIB, and 10 (58.8%) were at stage IIIA. Eleven (64.7%) had adenocarcinoma and 6 (35.3%) had squamous cell carcinoma. The most reasons of unfit for cisplatin regimen were old age (≥70 years old, n=14) and renal impairment (n=7). Ten of 17 patients (58.8 (32.9-81.6) %) completed four cycles of regimen. The reasons for discontinuation of the chemotherapy were febrile neutropenia (n=2), neutropenia (n=1), empyema (n=1), drug-induced pneumonitis (n=1), renal failure (n=1), and patient refusal due to fatigue (n=1). Three of 10 patients who completed four cycles needed dose reduction due to grade 4 neutropenia. Nab-paclitaxel on day 15 was omitted in 39 of 49 cycles (79.6%) because of grade 3 or 4 neutropenia. The most common grade 3 or 4 adverse event was neutropenia (n=14, 82.4%), followed by anemia (n=3, 17.6%). Febrile neutropenia, grade 3 pneumonitis, grade 1 peripheral sensory neuropathy were observed in 11.8%, 5.9%, 35.3% of the 17 patients respectively. The median time to disease recurrence was 24.4 (10.8-37.5) months.

      Conclusion

      Carboplatin and nab-paclitaxel as adjuvant chemotherapy for NSCLC unfit for cisplatin was not tolerable. Dose reduction should be considered in further study of adjuvant chemotherapy.

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