West HL et al. (2005) Advanced bronchioloalveolar carcinoma: a phase II trial of paclitaxel by 96-hour infusion (SWOG 9714): a Southwest Oncology Group study. Ann Oncol 16: 1076–1080

Bronchioloalveolar carcinoma (BAC) is a histologic subgroup of non-small-cell lung cancer (NSCLC) that accounts for 2–5% of new NSCLC cases. The relative infrequency of BAC has meant that few clinical trials for this disease have been performed. Focal BAC can be cured by resection, but no optimal therapy for multilobar or recurrent disease has been established. Paclitaxel is one of the most commonly used agents for the treatment of NSCLC, and prolonged infusion of paclitaxel has demonstrated significant activity in in vitro studies, clinical studies in NSCLC, and in anecdotal cases of BAC.

The Southwest Oncology Group 9714 phase II trial set out to determine whether 96-hour infusion of paclitaxel would demonstrate promising survival and response rates in patients with previously untreated advanced BAC. Partial responses were confirmed in 9% of the 58 patients analyzed in the study, and 40% had stable disease. The median overall survival and median time to disease progression were 12 months and 5 months, respectively. Grade 3 or greater toxicities were seen with neutropenia/granulocytopenia (43%), febrile neutropenia (12%), infection (22%) and stomatitis/pharyngitis (10%); there were also five deaths, which were likely to be treatment related.

The authors conclude that although 96-hour paclitaxel infusion is active in BAC, the toxicity is considerable. This trial shows that BAC can be studied effectively in a multi-institutional setting and provides a benchmark for assessing response rate and efficacy data for ongoing and future trials of BAC.