Effectiveness of nab-paclitaxel for malignant effusion in non-small cell lung cancer

Background Nanoparticle albumin-bound paclitaxel (nab-PTX) is currently one of standard therapeutic drugs for patients with advanced non-small cell lung cancer (NSCLC). Malignant effusion known as the common comorbidity in NSCLC evokes severe adverse events from chemotherapy and often fails to be controlled, leading to poor clinical outcome. The previous experimental reports showed that nab-PTX significantly reduced peritoneal metastasis and effusion associated with gastric and pancreatic cancers. In the clinical case reports, chemotherapy with nab-PTX plus platinum produced good response to metastatic thymic carcinoma with pleural effusion and peritoneal dissemination. However, there have been no reports about its effectiveness for NSCLC patients with malignant effusion. In this context, we investigated the effectiveness and safety of nab-PTX in NSCLC patients with effusion. Methods Forty patients who were treated with nab-PTX were enrolled in this study. The patients were classified into two groups according to the presence or absence of pleural or peritoneal effusion using computed tomography images. The clinicopathological characteristics and clinical outcomes were retrospectively evaluated with the statistical methods. Results There were 26 patients with effusion (15 males; mean age 67) and 14 patients without effusion (11 males; mean age 70). The objective response rate was 38.5% in patients with effusion. There were no statistical differences in clinical features involving progression-free survival (PFS) (141 days vs 147 days) and adverse events between the two groups. The groups of squamous cell carcinoma and performance status (PS) 0-1 had significant PFS benefits compared with those of other histological types (260 days vs 141 days; p<0.001) and PS 2-3 (151 days vs 38 days; p<0.001), respectively. The therapeutic response to malignant effusion was 80.7% in patients with effusion, whereas there were no correlations in therapeutic responses between malignant effusions and systemic lesions. Conclusions Chemotherapy with nab-PTX might be one of the potential therapeutic options for NSCLC patients coexisting malignant effusions. Legal entity responsible for the study Jichi Medical University Saitama Medical Center Funding Jichi Medical Univercity Disclosure All authors have declared no conflicts of interest.