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

Abstract

Background: Nanoparticle albumin-bound paclitaxel (nab-PTX) has exhibited clinical efficacy in breast cancer treatment, but toxicities can be yielded more at the same time. We did this meta-analysis aiming to unambiguously compare nab-PTX with conventional solvent-based paclitaxel (sb-PTX) in breast cancer patients of all stages. Method: Pubmed, Embase and Cochrane Library were searched for head-to-head randomized controlled trials of nab-PTX and sb-PTX in breast cancer. Risk ratio (RR) with 95% confidence interval was used for dichotomous variables while Hazard ratio (HR) was used for time-to-event outcomes. Results: Our review finally included 9 studies with 3508 patients. Nab-PTX showed a benefit on objective response rate (ORR) (RR=1.22 [1.04-1.43], P=0.01) as well as non-inferiority compared with sb-PTX in disease control rate (DCR) (RR=1.01 [0.98-1.04], P=0.44), overall survival (OS) (HR=0.99 [0.93-1.05], P=0.81) and disease free survival/progression free survival (DFS/PFS) (HR=0.92 [0.81-1.05], P=0.21). However, when it comes to toxicities (fatigue, nausea or vomiting, peripheral sensory neuropathy and adverse event related discontinuation), results favored sb-PTX (RR=2.89 [1.07-7.8], 3.15 [1.78-5.59], 2.11 [1.32-3.37], 2.02 [1.61-2.53]; P<0.05). Patients with metastatic tumors or undergoing conventional schedule responses better to nab-PTX than the compared groups (RR of ORR in metastatic vs early or locally advanced patients: 1.46 [1.09-1.96] vs 1.01 [0.94-1.08]; conventional vs dose dense group: 1.59 [1.23-2.06] vs 1.01 [0.91-1.12]). Conclusions: Nab-PTX can improve ORR compared with paclitaxel and should be given priority to when aiming to reduce tumor load in breast cancer. Sb-PTX of dose dense schedule is recommended when toxicity of nab-PTX is hard to bear for breast cancer patients.

Nab-Paclitaxel for Relapsed AIDS-Related Kaposi Sarcoma -A Case Report

“…15 There has been a meta-report showing that Nab-PTX can improve ORR compared with paclitaxel and should be given priority when aiming to reduce tumor load in breast cancer. 16 Nab-PTX, approved by the FDA in 2012 as the first line of neoadjuvant therapy for pancreatic cancer, is widely used in clinical work and significantly improves outcomes. 17 In this case, the patient relapsed after 8 cycles of Liposomal Doxorubicin chemotherapy, but tumor regression was observed by nab-paclitaxel.…”

Selection of breast cancer subtypes to improve benefits of intensive dose‑dense chemotherapy: A systematic meta‑analysis

“…Although adjuvant chemotherapy confers a one-third reduction in the 10-year risk of mortality from BC (2), a large number of patients will experience recurrence and BC-associated mortality (3). To improve the prognosis and sensitivity to chemotherapy of patients with BC, a new chemotherapy interval protocol has been proposed called intensive dose-dense (DD) chemotherapy, which consists of using the same chemotherapy agents and dosing but with shorter intervals between treatment cycles (4). Generally, the usual chemotherapy once every 3 weeks is shortened to once every 2 weeks to shorten the treatment time, improve the treatment effect, prolong the survival time of patients and improve the quality of life.…”

Co-delivery of paclitaxel and doxorubicin using polypeptide-engineered nanogels for combination therapy of tumor

“…To date, two major types of nanogels prepared with natural and synthetic polymers have been extensively studied as drug carriers [16,17]. The composition of natural materials is complex and inconvenient to study the relationship between their composition and properties, thus limiting their applications [18]. Synthetic polymer materials, such as Pluronic F127, polycaprolactone copolymers, are also limited in clinical applications due to their potential toxicity [19,20].…”