Is nab-paclitaxel a better option than standard solvent-based taxanes for women with breast cancer?

This study explored whether nanoparticle albumin-bound (nab) paclitaxel (Abraxane) is more efficient as chemotherapy before surgery compared to solvent-based (sb) taxanes in patients with breast cancer.

The authors found that nab-paclitaxel was able to improve the outcomes of these patients.

Breast cancer is one of the most common cancers affecting women worldwide. Chemotherapy is used before surgery to shrink a tumor when it is too big to be operable or to reduce the risk of cancer coming back. Sb-taxanes such as paclitaxel (Taxol) or docetaxel (Taxotere) are commonly used chemotherapy drugs before surgery. However, they can cause allergic reactions as they are composed of substances to make them more easily absorbed in the body. Therefore, they often need premedications and long infusion time to avoid these allergic reactions.

Nab-paclitaxel has been developed to avoid these problems. It is transported into the body via albumin (the main protein in the body). Therefore, it enters the body quickly and does not need premedications to avoid allergies. Few small studies also showed that nab-paclitaxel is more capable of reaching the tumor. However, few studies compared the effectiveness of nab-paclitaxel to sb-taxanes before surgery in patients with breast cancer.

The authors analyzed 7 studies including 2949 patients with breast cancer treated with nab-paclitaxel or sb-taxanes before surgery. 

Patients receiving nab-paclitaxel were 52% more likely to have the tumor completely removed after surgery compared to those who received sb-taxanes. These results were similar for different types of breast cancer, such as triple-negative, HER2-negative, and hormone receptor (HR) positive breast cancer.

Patients treated with nab-paclitaxel were 31% more likely to survive without complications from the cancer compared to those treated with sb-taxanes. 

Overall severe side effects were similar between nab-paclitaxel and sb-taxanes. However, nab-paclitaxel led to a 4 times higher risk of nerve damage.

The authors showed that nab-paclitaxel before surgery is generally safe and improves the outcomes of patients with breast cancer.

The study included works from different countries. Each country has a different way of recording side effects complete response to treatment. This might have influenced the results.