Role of nab-paclitaxel in metastatic breast cancer: a meta-analysis of randomized clinical trials

// Yun Liu 1, * , Guoxin Ye 2, * , Dali Yan 1 , Lei Zhang 3 , Fan Fan 4 and Jifeng Feng 1 1 Department of Medical Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210009, China 2 Division of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China 3 Department of General Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210009, China 4 Department of Medical Oncology, No.2 Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China * These authors have contributed equally to this work Correspondence to: Jifeng Feng, email: medfjif@sina.com Keywords: nab-paclitaxel, taxanes, chemotherapy, breast cancer, meta-analysis Received: January 13, 2017      Accepted: June 15, 2017      Published: June 30, 2017 ABSTRACT Whether nab-paclitaxel and conventional taxanes are equally effective for metastatic breast cancer (MBC) remains unclear. We conducted meta-analysis of trials that compared nab-paclitaxel-based chemotherapy with solvent-based paclitaxel (sb-paclitaxel) and docetaxel-based chemotherapy. A literature search was performed to identify articles that compared nab-paclitaxel-based chemotherapy with sb-paclitaxel or docetaxel-based chemotherapy for MBC. Four randomized controlled trials (1,506 patients) were identified from 1,268 reports. We detected equivalent overall response, overall survival, and survival probability (one-year, two-year). Grade 3 to 4 hematological and non-hematological toxicities were also comparable except that sensory neuropathy was more prominent for nab-paclitaxel-based chemotherapy (16.9% vs. 10%, odds ratio = 1.89, 95% confidence interval = 1.36–2.61, P < 0.001). No significant publication bias was detected. Consistent results stratified by treatment arm, study phase, treatment line, and study location were observed, except that overall response rate to nab-paclitaxel-based chemotherapy was significantly higher in the subgroup of randomized phase II trials, non-first-line treatment, and East Asian population. This meta-analysis failed to demonstrate advantages of nab-paclitaxel compared with sb-paclitaxel and docetaxel in patients with MBC. The newer agent was associated with increased sensory neuropathy, equivalent survival, and possibly increased overall response for some specific patients.