Evaluate the Clinical Outcome of Nanoparticle Albumin-bound Paclitaxel on Breast Cancer Treatment: A Systematic Review and Meta-analysis

Document Type : Review Article


1 Department of General Surgery, School of Medicine, Arak University of Medical Sciences, Arak, Iran

2 Department of pathology, Faculty of medicine, Sari Branch, Islamic Azad University, Sari, Iran

3 School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

4 School of Medicine, Islamic Azad University, Najaf Abad Branch, Najafabad, Iran

5 Department of Internal Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran


Background and aim: Nanoparticle albumin-bound paclitaxel can have a higher response rate than paclitaxel in women with metastatic breast cancer. Therefore, the present study was conducted to evaluate the clinical outcome of nanoparticle albumin-bound paclitaxel on breast cancer treatment.
Material and methods: All articles published in international databases such as PubMed, Scopus, Science Direct, ISI Web of knowledge, and Embase between March 2016 and August 2022 were included. 95% confidence interval (CI) for odds ratio and risk ratio with fixed effect modal and Mantel-Haenszel were calculated. Data analysis was performed using STATA.V16 software.
Results: In the initial review, the abstracts of 249 studies were reviewed, two authors reviewed the full text of 42 studies, and finally, nine studies were selected. The odds ratio of the Overall response rate in breast cancer patients between nab-paclitaxel and the control group was 0.22 (95% CI, 0.04 to 0.41; p=0.02) in breast cancer patients with been treated with neoadjuvant nab-paclitaxel, Overall response rate was higher.
Conclusions: Based on the findings of the present meta-analysis, complete pathological response and overall response rate were higher for the neoadjuvant nab-paclitaxel than conventional taxane regimens.


Main Subjects

[1]  Cao W, Chen HD, Yu YW, Li N, Chen WQ. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020. Chinese Medical Journal. 2021;134(07):783-91.
[2]  Amaria RN, Menzies AM, Burton EM, Scolyer RA, Tetzlaff MT, Antdbacka R, et al. Neoadjuvant systemic therapy in melanoma: recommendations of the International Neoadjuvant Melanoma Consortium. The Lancet Oncology. 2019;20(7):e378-89. https://doi.org/10.1016/S1470-2045(19)30332-8.
[3]  Zaheed M, Wilcken N, Willson ML, O'Connell DL, Goodwin A. Sequencing of anthracyclines and taxanes in neoadjuvant and adjuvant therapy for early breast cancer. Cochrane Database of Systematic Reviews. 2019(2). https://doi.org/10.1002/14651858.CD012873.pub2.
[4]  Rong D, Wang C, Zhang X, Wei Y, Zhang M, Liu D, et al. A novel taxane, difluorovinyl-ortataxel, effectively overcomes paclitaxel-resistance in breast cancer cells. Cancer letters. 2020;491:36-49. https://doi.org/10.1016/j.canlet.2020.06.025.
[5]  Gianni L, Eiermann W, Semiglazov V, Manikhas A, Lluch A, Tjulandin S, et al. Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. The Lancet. 2010;375(9712):377-84. https://doi.org/10.1016/S0140-6736(09)61964-4.
[6]  Earl HM, Vallier AL, Hiller L, Fenwick N, Young J, Iddawela M, et al. Effects of the addition of gemcitabine, and paclitaxel-first sequencing, in neoadjuvant sequential epirubicin, cyclophosphamide, and paclitaxel for women with high-risk early breast cancer (Neo-tAnGo): an open-label, 2× 2 factorial randomised phase 3 trial. The lancet oncology. 2014;15(2):201-12. https://doi.org/10.1016/S1470-2045(13)70554-0.
[7]  Sikov WM, Berry DA, Perou CM, Singh B, Cirrincione CT, Tolaney SM, et al. Impact of the addition of carboplatin and/or bevacizumab to neoadjuvant once-per-week paclitaxel followed by dose-dense doxorubicin and cyclophosphamide on pathologic complete response rates in stage II to III triple-negative breast cancer: CALGB 40603 (Alliance). Journal of clinical oncology. 2015;33(1):13-21. https://doi.org/10.1200%2FJCO.2014.57.0572.
[8]  Carey LA, Berry DA, Cirrincione CT, Barry WT, Pitcher BN, Harris LN, et al. Molecular heterogeneity and response to neoadjuvant human epidermal growth factor receptor 2 targeting in CALGB 40601, a randomized phase III trial of paclitaxel plus trastuzumab with or without lapatinib. Journal of Clinical Oncology. 2016;34(6):542-49. https://doi.org/10.1200%2FJCO.2015.62.1268.
[9]  Xu J, Ong HX, Traini D, Williamson J, Byrom M, Gomes Dos Reis L, et al. Paclitaxel-eluting silicone airway stent for preventing granulation tissue growth and lung cancer relapse in central airway pathologies. Expert Opinion on Drug Delivery. 2020;17(11):1631-45. https://doi.org/10.1080/17425247.2020.1811224.
[10] Gao Y, Nai J, Yang Z, Zhang J, Ma S, Zhao Y, et al. A novel preparative method for nanoparticle albumin-bound paclitaxel with high drug loading and its evaluation both in vitro and in vivo. PLoS One. 2021;16(4):e0250670. https://doi.org/10.1371/journal.pone.0250670.
[11] Kim JS, Suh KJ, Lee DW, Woo GU, Kim M, Kim SH, et al. A real-world efficacy of nab-paclitaxel monotherapy in metastatic breast cancer. Cancer Research and Treatment: Official Journal of Korean Cancer Association. 2022;54(2):488-96. https://doi.org/10.4143%2Fcrt.2021.394.
[12] Lee H, Park S, Kang JE, Lee HM, Kim SA, Rhie SJ. Efficacy and safety of nanoparticle-albumin-bound paclitaxel compared with solvent-based taxanes for metastatic breast cancer: A meta-analysis. Scientific Reports. 2020;10(1):1-9. https://doi.org/10.1038/s41598-019-57380-0.
[13] Yuan H, Guo H, Luan X, He M, Li F, Burnett J, et al. Albumin nanoparticle of paclitaxel (Abraxane) decreases while taxol increases breast cancer stem cells in treatment of triple negative breast cancer. Molecular pharmaceutics. 2020;17(7):2275-86. https://doi.org/10.1021/acs.molpharmaceut.9b01221.
[14] Gradishar WJ, Krasnojon D, Cheporov S, Makhson AN, Manikhas GM, Clawson A, et al. Significantly longer progression-free survival with nab-paclitaxel compared with docetaxel as first-line therapy for metastatic breast cancer. J Clin Oncol. 2009;27(22):3611-9. https://doi.org/10.1200/JCO.2008.18.5397.
[15] Zong Y, Wu J, Shen K. Nanoparticle albumin-bound paclitaxel as neoadjuvant chemotherapy of breast cancer: a systematic review and meta-analysis. Oncotarget. 2017;8(10):17360-72. https://doi.org/10.18632%2Foncotarget.14477.
[16] Wu YC, Chen CS, Chan YJ. The outbreak of COVID-19: An overview. Journal of the Chinese medical association. 2020;83(3):217-20. https://doi.org/10.1097%2FJCMA.0000000000000270.
[17] Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj. 2011;343. https://doi.org/10.1136/bmj.d5928.
[18] Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European journal of epidemiology. 2010;25(9):603-5. https://doi.org/10.1007/s10654-010-9491-z.
[19] Zhang W, Xu Y, Shi X, Huang X, Chen R, Xu H, et al. Nanoparticle albumin-bound paclitaxel is superior to liposomal paclitaxel in the neoadjuvant treatment of breast cancer. Nanomedicine. 2022;17(10):683-94. https://doi.org/10.2217/nnm-2022-0025.
[20] Untch M, Jackisch C, Schneeweiss A, Schmatloch S, Aktas B, Denkert C, et al. NAB-paclitaxel improves disease-free survival in early breast cancer: GBG 69–GeparSepto. Journal of Clinical Oncology. 2019;37(25):2226-34.
[21] Patel TA, Ensor JE, Creamer SL, Boone T, Rodriguez AA, Niravath PA, et al. A randomized, controlled phase II trial of neoadjuvant ado-trastuzumab emtansine, lapatinib, and nab-paclitaxel versus trastuzumab, pertuzumab, and paclitaxel in HER2-positive breast cancer (TEAL study). Breast Cancer Research. 2019;21(1):1-9.
[22] Xie F, Chen R, Zhang L, Yin Z, Zhu Q, You S, et al. Efficacy of two-weekly nanoparticle albumin-bound paclitaxel as neoadjuvant chemotherapy for breast cancer. Nanomedicine. 2019;14(12):1595-603. https://doi.org/10.2217/nnm-2018-0485.
[23] Gianni L, Mansutti M, Anton A, Calvo L, Bisagni G, Bermejo B, et al. Comparing neoadjuvant nab-paclitaxel vs paclitaxel both followed by anthracycline regimens in women with ERBB2/HER2-negative breast cancer—the evaluating treatment with neoadjuvant abraxane (ETNA) trial: a randomized phase 3 clinical trial. JAMA oncology. 2018;4(3):302-8.
[24] Moebus V, Noeding S, Ladda E, Klare P, Schmidt M, Schneeweiss A, et al. Neo-/adjuvant phase III trial to compare intense dose-dense (idd) treatment with EnPC to tailored dose-dense (dt) therapy with dtEC-dtD for patients with high-risk early breast cancer: Results on pathological complete response (pCR) for patients treated within the neoadjuvant setting. 2018;36(15):568.
[25] Kuwayama T, Nakamura S, Hayashi N, Takano T, Tsugawa K, Sato T, et al. Randomized multicenter phase II trial of neoadjuvant therapy comparing weekly Nab-paclitaxel followed by FEC with docetaxel followed by FEC in HER2− early-stage breast cancer. Clinical breast cancer. 2018;18(6):474-80. https://doi.org/10.1016/j.clbc.2018.06.012.
[26] Nahleh ZA, Barlow WE, Hayes DF, Schott AF, Gralow JR, Sikov WM, et al. SWOG S0800 (NCI CDR0000636131): addition of bevacizumab to neoadjuvant nab-paclitaxel with dose-dense doxorubicin and cyclophosphamide improves pathologic complete response (pCR) rates in inflammatory or locally advanced breast cancer. Breast cancer research and treatment. 2016;158(3):485-95. https://doi.org/10.1007/s10549-016-3889-6.
[27] Matsuda N, Wang X, Krishnamurthy S, Alvarez RH, Willey JS, Lim B, et al. Phase II study of panitumumab, nab-paclitaxel, and carboplatin followed by FEC neoadjuvant chemotherapy for patients with primary HER2-negative inflammatory breast cancer. 2016;34(15):1087.
[28] Ceccon G, Wollring M, Brunn A, Deckert M, Waldschmidt D, Fink GR, et al. Leptomeningeal carcinomatosis in a patient with pancreatic cancer responding to nab-paclitaxel plus gemcitabine. Case reports in oncology. 2020;13(1):35-42. https://doi.org/10.1159/000504697.
[29] Desai N, Trieu V, Damascelli B, Soon-Shiong P. SPARC expression correlates with tumor response to albumin-bound paclitaxel in head and neck cancer patients. Translational oncology. 2009;2(2):59-64. https://doi.org/10.1593/tlo.09109.
[30] Liu M, Liu S, Yang L, Wang S. Comparison between nab-paclitaxel and solvent-based taxanes as neoadjuvant therapy in breast cancer: a systematic review and meta-analysis. BMC cancer. 2021;21(1):1-3. https://doi.org/10.1186/s12885-021-07831-7.
[31] Hamilton E, Kimmick G, Hopkins J, Marcom PK, Rocha G, Welch R, et al. Nab-paclitaxel/bevacizumab/carboplatin chemotherapy in first-line triple negative metastatic breast cancer. Clinical Breast Cancer. 2013;13(6):416-20. https://doi.org/10.1016/j.clbc.2013.08.003.
[32] Lobo C, Lopes G, Baez O, Castrellon A, Ferrell A, Higgins C, et al. Final results of a phase II study of nab-paclitaxel, bevacizumab, and gemcitabine as first-line therapy for patients with HER2-negative metastatic breast cancer. Breast cancer research and treatment. 2010;123(2):427-35. https://doi.org/10.1007/s10549-010-1002-0.
[33] Dranitsaris G, Coleman R, Gradishar W. nab-Paclitaxel weekly or every 3 weeks compared to standard docetaxel as first-line therapy in patients with metastatic breast cancer: an economic analysis of a prospective randomized trial. Breast cancer research and treatment. 2010;119(3):717-24. https://doi.org/10.1007/s10549-009-0424-z.
[34] Dranitsaris G, Cottrell W, Spirovski B, Hopkins S. Economic analysis of albumin-bound paclitaxel for the treatment of metastatic breast cancer. Journal of Oncology Pharmacy Practice. 2009;15(2):67-78. https://doi.org/10.1177%2F1078155208098584.
Volume 4, Issue 3
September 2022
Pages 127-133
  • Receive Date: 05 June 2022
  • Revise Date: 25 July 2022
  • Accept Date: 10 August 2022
  • First Publish Date: 22 August 2022