Comparison between nab-paclitaxel and solvent-based taxanes as neoadjuvant therapy in breast cancer: a systematic review and meta-analysis

BackgroundTo compare the efficacy and safety of nanoparticle albumin-bound paclitaxel (nab-paclitaxel) and solvent-based taxanes (sb-taxanes) as neoadjuvant therapy in the treatment of breast cancer.MethodsWe systematically searched the PubMed, Embase, and Cochrane Central Register databases. Randomized controlled trials (RCTs) and cohort studies, published in English, about the comparison between nab-paclitaxel and sb-taxanes as neoadjuvant therapy in patients with breast cancer were searched up to September 2019.ResultsThe primary outcome was the proportion of patients with pathological complete response (pCR, defined as ypT0 ypN0 or ypT0/is ypN0). Other main outcomes included long-term survival and adverse events (AEs). Seven studies (five RCTs and two cohorts) and 2949 patients were included. Neoadjuvant nab-paclitaxel improved pCR compared with sb-taxanes (ypT0 ypN0: OR=1.52, 95%CI: 1.27-1.83, P<0.001; ypT0/is ypN0: OR=1.40, 95%CI: 1.17-1.68, P<0.001). The benefits of nab-paclitaxel on pCR were persistent in HER2-negative, hormone receptor (HR)-positive breast cancer (OR=1.53, 95%CI: 1.07-2.19, P=0.020), triple-negative breast cancer (weekly/every 2weeks regimen; OR=2.95, 95%CI: 1.54-5.67, P<0.001), and tumors with Ki-67>20% (OR=1.63, 95%CI: 1.26-2.12, P<0.001). Patients treated with nab-paclitaxel had better event-free survival (EFS; HR=0.69, 95%CI: 0.57-0.85, P<0.001) than with sb-taxanes. There were no differences in most of grade > 3 AEs between nab-paclitaxel and sb-taxanes (all P>0.05), besides of any grade hypersensitivity (OR=0.29, 95%CI: 0.11-0.72, P=0.008), any grade (OR=2.10, 95%CI: 1.37-3.23, P=0.001) and grade > 3 (OR=4.01, 95%CI: 2.51-6.41, P<0.001) neuropathy.ConclusionNab-paclitaxel is effective for the treatment of non-metastatic breast cancer in the neoadjuvant setting. Nab-paclitaxel could improve pCR rate and EFS compared with sb-taxanes and with reasonable toxicities.