Variability of PTX exposure using BSA dosing is well documented and often leads to severe toxicities. While carboplatin is dosed to obtain a specific exposure, paclitaxel is conventionally dosed by BSA, leading to a wide range of exposure. This study compared PTX PK-guided dosing to BSA dosing in a PTX-carboplatin regimen treating stage IIIB/IV NSCLC. This is the final analysis of interim results presented at ASCO 2015 (Poster #375). ClinicalTrials.gov Identifier NCT02058433.
309 patients with stage IIIB/IV NSCLC were randomized to receive up to 4 cycles of first line 3-weekly carboplatin (AUC 5) and a PTX dose of 175 mg/m2 (Arm A), or a PTX PK-guided dose (Arm B) to achieve a time above a PTX plasma concentration of 0.05µM (Tc>0.05) for 26 to 31 hours. Response was classified according to Response Evaluation Criteria in Solid Tumors Group. PTX concentrations were measured by immunoassay; Tc>0.05 was calculated with PK software. The primary endpoint was reduction of grade 4 hematological toxicities.
There were 164 patients in Arm A and 155 patients in Arm B, with 191 males and 128 females participating. PK-guided dose adjustment resulted in doses that were widely distributed 73 – 175 mg/m2, and statistically lower than in the BSA arm (by 24%, p
Results of this study are in agreement with a previous report, and present further evidence that PK-guided dosing reduces severe toxicities. This is accomplished by an overall lowering of dose intensity, while still maintaining efficacy. PK-guided dosing personalizes chemotherapy, and may be useful in patient management.
Clinical trial identification
Legal entity responsible for the study
Tonji University Affiliated Shanghai Pulmonary Hospital, Tongji University
All authors have declared no conflicts of interest.