Efficacy and safety of nanoparticle-albumin-bound paclitaxel compared with solvent-based taxanes for metastatic breast cancer: A meta-analysis

Abstract

The curative effects of nanoparticle albumin-bound (nab)-paclitaxel in the first-line treatment of metastatic breast cancer (MBC) are still controversial, with even more after the removal of marketing approval of indication of bevacizumab. Five electronic databases and the related resources were searched for eligible randomized clinical trials (RCTs) without year and language restrictions to perform a meta-analysis. The studies were comparing the efficacy and safety between nab-paclitaxel chemotherapy versus solvent-based (sb)-taxanes chemotherapy such as sb-paclitaxel and docetaxel. The primary end points were overall response rate (ORR) and disease control rate (DCR). Secondary end points were progression-free survival (PFS), overall survival (OS), adverse events (AEs), and dose discontinuation rate (DDR). Five RCTs (1,554 patients) were finally identified from 1,902 studies. When compared to sb-paclitaxel, nab-paclitaxel showed significant beneficial effects in terms of ORR (OR 2.39, 95% CI 1.69-3.37, p < 0.001), DCR (OR 1.89, 95% CI 1.07-3.35, p = 0.03), and PFS (HR 0.75, 95% CI 0.62-0.90, p = 0.002). Nab-paclitaxel also showed significantly longer OS (HR 0.73, 95% CI 0.54-0.99, p = 0.04) than docetaxel. AEs and DDR were comparable between the two arms. Using nab-paclitaxel could significantly improve efficacy with comparable toxicities in the treatment of MBC. Nanoparticle albumin-bound (nab) paclitaxel is solvent free and employs a novel delivery mechanism for paclitaxel to tumors 1. Although nab-paclitaxel was initially developed to minimize the toxic effects of taxane treatment, several early clinical trials demonstrated that nab-paclitaxel was also more effective than the conventional solvent-based (sb) paclitaxel in the treatment of metastatic breast cancer 2-5. However, recent randomized controlled trials (RCTs) have suggested that nab-paclitaxel chemotherapy is not as efficacious as sb-taxanes, such as sb-paclitaxel and docetaxel, and that nab-paclitaxel is often associated with more frequent adverse events 6. For example, Rugo et al. showed that nab-paclitaxel was not superior to sb-paclitaxel (progression-free survival [PFS] 9.3 months vs 11 months, hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.00-1.45, p = 0.054). Results were concordant with overall survival (OS), and time to treatment failure was significantly shorter in the nab-paclitaxel arm vs the sb-paclitaxel arm 6. Hematologic and non-hematologic toxicity, including peripheral neuropathy, was more prevalent in the nab-paclitaxel arm, which also had more frequent and earlier dose reductions 6. After these conflicting results were generated, Liu et al. conducted a first meta-analysis of randomized clinical trials to evaluate the efficacy and toxicity of nab-paclitaxel compared with sb-paclitaxel and docetaxel in the

Albumin-bound paclitaxel and gemcitabine combination therapy in soft tissue sarcoma

“…[23] Several previous studies have demonstrated that nab-paclitaxel has greater efficacy and a more favorable safety profile (compared with solvent-based paclitaxel) in many malignancies. [13,24,25] To our knowledge, this study is the first to investigate the safety and effectiveness of nab-paclitaxel/ gemcitabine combination chemotherapy in patients with advanced STS. In this retrospective observational study, we observed that nab-paclitaxel was effective for the treatment of STS, with an ORR of 47.1%, and an m-PFS of seven months.…”

Albumin-bound paclitaxel and gemcitabine combination therapy in soft tissue sarcoma

“…[23] Several previous studies have demonstrated that nab-paclitaxel has greater e cacy and a more favorable safety pro le (compared with solvent-based paclitaxel) in many malignancies. [13,24,25] To our knowledge, this study is the rst to investigate the safety and effectiveness of nab-paclitaxel/ gemcitabine combination chemotherapy in patients with advanced STS. In this retrospective observational study, we observed that nab-paclitaxel was effective for the treatment of STS, with an ORR of 47.1%, and an m-PFS of seven months.…”

“…The results of our study indicate that nab-paclitaxel is more effective and has lower toxicity than conventional paclitaxel or docetaxel in STS. In view of the fact that nab-paclitaxel is superior to conventional paclitaxel in the treatment of many malignant tumors, [13,24,25] nab-paclitaxel should not simply be considered as a drug with similar properties to paclitaxel. It should be regarded as a new chemotherapeutic drug; and the e cacy of this drug should be evaluated in various malignancies.…”

Albumin-bound paclitaxel and gemcitabine combination therapy in soft tissue sarcoma

“…According to clinical data, nab-paclitaxel offers several improvements over conventional, solvent-and Cremophor-based paclitaxel, including lower toxicities, shorter administration time, higher e cacy, and the lack of a need for premedication [23]. Several previous studies have demonstrated that nab-paclitaxel has greater e cacy and a more favorable safety pro le (compared with solvent-based paclitaxel) in many malignancies [13,24,25].…”

“…The results of our study indicate that nab-paclitaxel is more effective and has lower toxicity than conventional paclitaxel or docetaxel in STS. In view of the fact that nab-paclitaxel is superior to conventional paclitaxel in the treatment of many malignant tumors [13,24,25], nab-paclitaxel should not simply be considered as a drug with similar properties to paclitaxel. It should be regarded as a new chemotherapeutic drug; and the e cacy of this drug should be evaluated in various malignancies.…”