Abstract
BackgroundTo 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.MethodsWe 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.ResultsThe 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.ConclusionNab-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.
Highlights
To compare the efficacy and safety of nanoparticle albumin-bound paclitaxel and solvent-based taxanes as neoadjuvant therapy in the treatment of breast cancer
Neoadjuvant nab-paclitaxel improved pathological complete response (pCR) compared with sb-taxanes
The benefits of nab-paclitaxel on pCR were persistent in Human epidermal growth factor receptor 2 (HER2)-negative, hormone receptor (HR)positive breast cancer (OR = 1.53, 95%confidence intervals (CIs): 1.07–2.19, P = 0.020), triple-negative breast cancer, and tumors with Ki-67 > 20% (OR = 1.63, 95%CI: 1.26–2.12, P < 0.001)
Summary
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. Neoadjuvant chemotherapy is an established treatment to downstage inoperable or locally advanced cancers into operable cancers and to decrease the tumor size, and to allow. Conventional solvent-based (sb) taxanes (including paclitaxel and docetaxel) prevent cell proliferation by stabilizing the microtubules and are among the most widely used chemotherapy agents for breast cancer [6, 7]. A regimen of taxane-, alkylator-, and anthracycline-based chemotherapy is a standard-of-care for potentially operable breast cancer [2]. The addition of sb-taxanes to the alkylator−/anthracycline-based regimen improves the clinical response, pCR rate, disease-free survival (DFS), and overall survival (OS) [8]. The cremophor excipient traps paclitaxel in micelles, resulting in nonlinear pharmacokinetics [11, 12]
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