Comparison of One-Week Versus Three-Week Paclitaxel Adjuvant Chemotherapy for Advanced Pan-Carcinomas: Systematic Review and Meta-Analysis

Background: Paclitaxel remains the first-line chemotherapy regime for many malignant tumors. However, prognosis and adverse events under different dosing regimens (one-week versus three-week treatment) remain contradictory in many randomized controlled trials (RCTs). Here, we performed a comprehensive meta-analysis to measure the efficacy and toxicities of these two dosing regimens. Methods: Four databases were systematically retrieved from inception to December 2020. RCTs comparing one-week or three-week paclitaxel treatment for advanced malignant tumors with assessable outcomes (e.g., overall survival (OS), progression-free survival (PFS)) were included. Findings: In total, 19 eligible RCTs involving 9 674 patients were included. Meta-analysis of pan-cancers revealed that weekly paclitaxel treatment was more beneficial regarding PFS compared to three-week paclitaxel treatment (hazard ratio (HR) = 0.90, 95% confidence interval (CI) = 0.82–0.99, P = 0.02). Nevertheless, there was no significant difference in terms of OS between the two dosing regimens (HR = 0.98, 95%CI = 0.91–1.06, P = 0.62). In terms of serious adverse events, grade 3 or 4 (G3/4) neutropenia (odds ratio (OR) = 0.60, 95%CI = 0.40–0.89, P = 0.01), G3/4 febrile neutropenia (OR = 0.67, 95%CI = 0.47–0.97, P = 0.03), G3/4 arthritis (OR = 0.34, 95%CI = 0.17–0.66, P = 0.001), and G3/4 alopecia (OR = 0.31, 95%CI = 0.19–0.49, P < 0.00001) occurred less often under weekly paclitaxel treatment compared to the three-week paclitaxel regimen. Interpretation: In summary, compared to the three-week paclitaxel regimen, weekly paclitaxel treatment demonstrates better PFS and fewer chemotherapy-induced hematological and non-hematological toxicities. Funding Information: This work was supported by National Natural Science Foundation of China (82072895, 81630060), and the research-oriented clinician funding program of Tongji Medical College, Huazhong University of Science and Technology. Declaration of Interests: The authors declare that there is no conflict of interest regarding the publication of this paper.