Efficacy and Safety of Albumin-bound Paclitaxel Versus Solvent-based Paclitaxel in Breast Cancer: A Meta-analysis

Abstract

Objective: A meta-analysis was performed to evaluate the safety and efficacy of albumin-bound paclitaxel (Nab-PTX) versus solvent-based paclitaxel (Sb-PTX) for breast cancer. Methods: In this systematic review and network meta-analysis, we searched databases including PubMed, Embase, and Cochrane-Library, for randomized controlled trials on the safety and efficacy of Nab-PTX and Sb-PTX for breast cancer. Pathologic complete response (pCR), objective response rate (ORR), and adverse events (AEs) were collated and analyzed using the meta-package in the R language. Results: A total of 13 studies (comprising 4252 patients) met the inclusion criteria, in which 9 studies adopted neoadjuvant chemotherapy and 4 adopted d conventional chemotherapy for breast cancer. Trails with neoadjuvant chemotherapy revealed that Nab-PTX resulted in a significantly higher pCR (0.280 [95% confidence interval (CI): 0.218-0.341]) and a higher ORR (0.822 [95% CI: 0.719-0.924]) versus Sb-PTX (0.163 [95% CI: 0.098-0.227], 0.770 [95% CI: 0.681-0.859]). In conventional chemotherapy, Sb-PTX and Nab-PTX showed a similar ORR (0.343 [95% CI: 0.204-0.483] vs. 0.438 [95% CI: 0.317-0.559] [odds ratio=1.53, 95% CI: 0.88-2.67]. In terms of AEs, the incidence of all grade-peripheral sensory neuropathy (PSN) and grade≥3 PSN for Sb-PTX was 0.392 (95% CI: 0.243-0.541) and 0.020 (95% CI: 0.009-0.031), and for Nab-PTX was 0.591 (95% CI: 0.452-0.729) and 0.087 (95% CI: 0.046-0.031). Conclusion: Neoadjuvant chemotherapy using Nab-PTX significantly enhanced the pCR and ORR of breast cancer patients, while conventional chemotherapy showed no significant pCR and ORR benefits. Given the significantly increased incidence of PSN, neoadjuvant chemotherapy using Nab-PTX requires caution in its clinical application.