Nanoparticle albumin-bound paclitaxel as neoadjuvant chemotherapy of breast cancer: a systematic review and meta-analysis

Yu Zong, Jiayi Wu, Kunwei Shen, Yu Zong, Jiayi Wu, Kunwei Shen

Abstract

Background: The value of nanoparticle albumin-bound paclitaxel (nab-paclitaxel) in neoadjuvant systemic therapy for breast cancer remains uncertain.

Methods: Both 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.

Results: Twenty-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.

Conclusion: nab-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.

Keywords: breast cancer; nab-paclitaxel; neoadjuvant; pathological complete response; toxicity.

Conflict of interest statement

CONFLICTS OF INTEREST

The authors have no conflicts of interest to report.

Figures

Figure 1. The flow chart summarizing the…
Figure 1. The flow chart summarizing the process for the identification of the eligible studies
Figure 2. Forest plots of probability achieving…
Figure 2. Forest plots of probability achieving pCR in unselected breast cancer patients with pCR definition of (A) ypT0/isN0; (B) ypT0N0; (C) ypT0/is
Figure 2. Forest plots of probability achieving…
Figure 2. Forest plots of probability achieving pCR in unselected breast cancer patients with pCR definition of (A) ypT0/isN0; (B) ypT0N0; (C) ypT0/is
Figure 2. Forest plots of probability achieving…
Figure 2. Forest plots of probability achieving pCR in unselected breast cancer patients with pCR definition of (A) ypT0/isN0; (B) ypT0N0; (C) ypT0/is
Figure 3. Forest plots of probability achieving…
Figure 3. Forest plots of probability achieving pCR(ypT0/isN0) in (A) HR+/HER2- group; (B) TNBC group; (C)HER2+ group; (D) HR+/HER2+ group; (E) HR-/HER2+ group
Figure 3. Forest plots of probability achieving…
Figure 3. Forest plots of probability achieving pCR(ypT0/isN0) in (A) HR+/HER2- group; (B) TNBC group; (C)HER2+ group; (D) HR+/HER2+ group; (E) HR-/HER2+ group
Figure 3. Forest plots of probability achieving…
Figure 3. Forest plots of probability achieving pCR(ypT0/isN0) in (A) HR+/HER2- group; (B) TNBC group; (C)HER2+ group; (D) HR+/HER2+ group; (E) HR-/HER2+ group
Figure 3. Forest plots of probability achieving…
Figure 3. Forest plots of probability achieving pCR(ypT0/isN0) in (A) HR+/HER2- group; (B) TNBC group; (C)HER2+ group; (D) HR+/HER2+ group; (E) HR-/HER2+ group
Figure 3. Forest plots of probability achieving…
Figure 3. Forest plots of probability achieving pCR(ypT0/isN0) in (A) HR+/HER2- group; (B) TNBC group; (C)HER2+ group; (D) HR+/HER2+ group; (E) HR-/HER2+ group
Figure 4
Figure 4
A. Forest plots of odds ratios for pCR within randomized clinical trials. B. Funnel plot
Figure 4
Figure 4
A. Forest plots of odds ratios for pCR within randomized clinical trials. B. Funnel plot

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