Abstract
BackgroundThe value of nanoparticle albumin-bound paclitaxel (nab-paclitaxel) in neoadjuvant systemic therapy for breast cancer remains uncertain.MethodsBoth electronic databases and proceedings of oncologic meetings were included in systematic literature search. Pooled rates of pathological complete response (pCR), odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using fixed-effect or random-effect model to determine the effect of neoadjuvant nab-paclitaxel.ResultsTwenty-one studies with 2357 patients were included, 3 of which were randomized clinical trials. The aggregate pCR(ypT0/is ypN0) rate was 32% (95% CI 25-38%) in unselected breast cancer patients and variated in different subtypes. Within randomized clinical trials, the probability of achieving pCR was significantly higher in the nab-paclitaxel group than in the conventional taxanes group (OR = 1.383, 95%CI 1.141-1.676, p = 0.001). For non-hematological toxic effect, any grade and grade 3-4 peripheral sensory neuropathy occurred more frequently with nab-paclitaxel compared to paclitaxel (any grade, OR = 2.090, 95%CI 1.016-4.302, p = 0.045; grade3-4, OR = 3.766, 95%CI 2.324-6.100, p < 0.001). Hypersensitivity was more common with paclitaxel than nab-paclitaxel at any grade and grade 3-4.Conclusionnab-paclitaxel is an effective cytotoxic drug in neoadjuvant treatment of breast cancer, especially for aggressive tumors in terms of pCR. Exchange of nab-paclitaxel for conventional taxanes could significantly improve pCR rate with reasonable toxicities.
Highlights
Breast cancer is the most common malignancy in women worldwide, and one of the leading causes of cancer death [1]
In this systematic review and meta-analysis, we demonstrate that nab-paclitaxel is an effective cytotoxic drug as in neoadjuvant chemotherapy for primary breast cancer patients, especially in aggressive subtypes
This is the first meta-analysis of randomized clinical trials in breast cancer, indicating neoadjuvant nabpaclitaxel significantly improved pathologic complete response (pCR) rate compared to conventional taxanes with generally reasonable toxicity profiles
Summary
Breast cancer is the most common malignancy in women worldwide, and one of the leading causes of cancer death [1]. Neoadjuvant systemic therapy (NST) has become a widely accepted choice to treat patients with operable and locally advanced breast cancer [2]. Patients attained pathologic complete response (pCR) after NST have significantly improved long-term survival when compared to those did not [3,4]. Taxanes are essential in the adjuvant treatment of lymph-node-positive or high-risk, lymph-node-negative breast cancer [5], and significantly increased clinical response and pCR rates for operable breast cancer in the neoadjuvant setting [6]. Neoadjuvant paclitaxel significantly increased tumor response, and improved survival outcome in those patients who achieved pCR [7,8,9,10,11,12,13]. The value of nanoparticle albumin-bound paclitaxel (nab-paclitaxel) in neoadjuvant systemic therapy for breast cancer remains uncertain
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