Role of nab-paclitaxel in metastatic breast cancer: a meta-analysis of randomized clinical trials
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Yun Liu1,*, Guoxin Ye2,*, Dali Yan1, Lei Zhang3, Fan Fan4 and Jifeng Feng1
1Department of Medical Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210009, China
2Division of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
3Department of General Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210009, China
4Department of Medical Oncology, No.2 Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
*These authors have contributed equally to this work
Jifeng Feng, email: [email protected]
Keywords: nab-paclitaxel, taxanes, chemotherapy, breast cancer, meta-analysis
Received: January 13, 2017 Accepted: June 15, 2017 Published: June 30, 2017
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.
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