Simvastatin (Zocor) in combination with paclitaxel (Taxol) may provide treatment benefit compared to paclitaxel alone for small cell lung cancer

1. Simvastatin (Zocor) in combination with paclitaxel (Taxol) is well tolerated and associated with significantly reduced disease progression compared to paclitaxel alone as a second-line treatment for small cell lung cancer (SCLC).

Evidence Rating Level: 1 (Excellent)

Standard first-line treatment for SCLC demonstrates a high objective response rate (ORR). However, most patients relapse within 6 months of treatment completion. Paclitaxel-based regimens are commonly used in second-line treatment. However, rapid drug resistance is common. Recent studies have shown that altered cholesterol synthesis pathways in cancer cells may contribute to this resistance, and that statins can delay its onset. This study aimed to explore whether paclitaxel in combination with a statin can improve treatment outcomes and delay the onset of resistance. This prospective, randomized, controlled, open-label, phase II, parallel-group superiority trial included patients aged 18-75 years with SCLC and resistance to at least one line of chemotherapy. Patients were randomized to receive nab-paclitaxel (nab-P 260 mg/m² on day 1 of each 21-day cycle, for 4 to 6 cycles; n = 18; mean [SD] age, 63.22 [8.33] years; 5.56% female) alone or nab-paclitaxel in combination with simvastatin (simvastatin 20 mg daily; n = 14; mean [SD] age, 64.43 [4.75] years; 0% female). The primary endpoint was disease control rate (DCR), defined as the proportion of patients achieving complete response (CR), partial response (PR), or stable disease (SD). No patients in either arm achieved a complete response. The combination arm had significantly greater PR rates (50.0% vs. 11.1%; p = 0.017), DCR rates (92.9% vs. 44.4%; p = 0.005), and progression-free survival (113 days vs. 62 days; p = 0.029). A significantly smaller proportion of patients in the combination arm had progressive disease (7.1% vs. 50.0%; p = 0.011). The addition of simvastatin did not significantly increase the incidence or severity of treatment-related adverse events. Overall, simvastatin in combination with paclitaxel may lead to better outcomes as a second-line treatment for SCLC.

Click here to read the study in BMC Medicine

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