Comparison between nab-paclitaxel and solvent-based taxanes as neoadjuvant therapy in breast cancer: a systematic review and meta-analysis

Abstract

Background To compare the efficacy and safety of nanoparticle albumin-bound paclitaxel (nab-paclitaxel) and solvent-based taxanes (sb-taxanes) as neoadjuvant therapy in the treatment of breast cancer. Methods We systematically searched the PubMed, Embase, and Cochrane Central Register databases. Randomized controlled trials (RCTs) and cohort studies, published in English, about the comparison between nab-paclitaxel and sb-taxanes as neoadjuvant therapy in patients with breast cancer were searched up to September 2019. Results The primary outcome was the proportion of patients with pathological complete response (pCR, defined as ypT0 ypN0 or ypT0/is ypN0). Other main outcomes included long-term survival and adverse events (AEs). Seven studies (five RCTs and two cohorts) and 2949 patients were included. Neoadjuvant nab-paclitaxel improved pCR compared with sb-taxanes (ypT0 ypN0: OR = 1.52, 95%CI: 1.27–1.83, P < 0.001; ypT0/is ypN0: OR = 1.40, 95%CI: 1.17–1.68, P < 0.001). The benefits of nab-paclitaxel on pCR were persistent in HER2-negative, hormone receptor (HR)-positive breast cancer (OR = 1.53, 95%CI: 1.07–2.19, P = 0.020), triple-negative breast cancer (weekly/every 2 weeks regimen; OR = 2.95, 95%CI: 1.54–5.67, P < 0.001), and tumors with Ki-67 > 20% (OR = 1.63, 95%CI: 1.26–2.12, P < 0.001). Patients treated with nab-paclitaxel had better event-free survival (EFS; HR = 0.69, 95%CI: 0.57–0.85, P < 0.001) than with sb-taxanes. There were no differences in most of grade > 3 AEs between nab-paclitaxel and sb-taxanes (all P > 0.05), besides of any grade hypersensitivity (OR = 0.29, 95%CI: 0.11–0.72, P = 0.008), any grade (OR = 2.10, 95%CI: 1.37–3.23, P = 0.001) and grade > 3 (OR = 4.01, 95%CI: 2.51–6.41, P < 0.001) neuropathy. Conclusion Nab-paclitaxel is effective for the treatment of non-metastatic breast cancer in the neoadjuvant setting. Nab-paclitaxel could improve pCR rate and EFS compared with sb-taxanes and with reasonable toxicities.

Potentially Overestimated Efficacy of Nanoparticle Albumin-bound Paclitaxel compared with Solvent-based Paclitaxel in Breast Cancer: A Systemic Review and Meta-analysis

“…But RR for ORR of patients undergoing neoadjuvant chemotherapy (i.e. early or locally advanced patients) was not significant ( Figure S1 ) which differed from other studies 13 - 14 . The reason might lie in the following 3 reasons: 1) we used ORR rather than pCR to evaluated the effect; 2) docetaxel, which was included in their studies, has different chemical structure and toxicity profile, and could make the result more confusing; 3) these studies have also included observational studies.…”

“…Unlike previous meta-analyses [13][14][15][16], we have restricted the comparison group as only sb-PTX instead of sb-taxanes (sb-PTX and docetaxel) to exclude the influence of docetaxel which is of different chemical structure with the other two taxanes. But as related studies are limited, we have also enlarged our scope of included study to all stages of breast cancer to increase our sample size as possible as we can.…”

“…There are three meta-analyses [13][14][15][16] which compared nab-PTX with sb-PTX in the subgroup analysis, while one [15] has mixed sb-PTX with docetaxel up and no such subgroup analysis was done. Among the former three, two studies [13][14] regarding neoadjuvant chemotherapy included retrospective trials or cohort trials and therefore lack credibility. The remaining one only included two trials [10,17] and omitted one important study of high recruitment [18] with no reason supplied.…”

A Canadian national guideline on the neoadjuvant treatment of invasive breast cancer, including patient assessment, systemic therapy, and local management principles

“…Targeted gray literature review did not demonstrate any impact on the accuracy or relevance of existing consensus statements. However, five additional recommendations were created by the expert guideline panel to reflect important areas of practice deemed not to be captured in the initial or revised statements This included statements on sentinel lymph node biopsy for N0 disease [16], nabpaclitaxel for neoadjuvant therapy [17,18], and two additional adjuvant therapies, neratinib [19] and olaparib [20]. Finally, the rapidly evolving impact of molecular gene profiling on NABC was decided to be more clearly addressed manner while seeking to minimize toxicities, with a focus on individualized decision making, including clinical trial enrollment, particularly where evidence is less robust or still accumulating.…”

Albumin-Bound Paclitaxel: Worthy of Further Study in Sarcomas

“…Several recent clinical trials have shown that nab-paclitaxel is effective for the treatment of non-metastatic breast cancer in the neoadjuvant setting. Nab-paclitaxel improved the pathological complete response rate and event-free survival compared with traditional taxanes, and with acceptable toxicities (63). Current studies of nab-paclitaxel in breast cancer have focused on dose adjustment and combination regimens with other drugs (64)(65)(66)(67)(68).…”