Efficacy and safety of nanoparticle albumin-bound paclitaxel in advanced non-small cell lung cancer: A systematic review and meta-analysis of clinical trials and observational studies

Nittiya Suwannasom; Netsai Sriaksorn; Chutamas Thepmalee; Chonthida Thephinlap; Patcharawan Tanamatayarat; Krissana Khoothiam; Hans Bäuemler; Nat Na-Ek

doi:10.1016/j.heliyon.2023.e21903

Efficacy and safety of nanoparticle albumin-bound paclitaxel in advanced non-small cell lung cancer: A systematic review and meta-analysis of clinical trials and observational studies

Heliyon. 2023 Nov 1;9(11):e21903. doi: 10.1016/j.heliyon.2023.e21903. eCollection 2023 Nov.

Authors

Nittiya Suwannasom¹, Netsai Sriaksorn¹, Chutamas Thepmalee¹, Chonthida Thephinlap¹, Patcharawan Tanamatayarat^{2

3}, Krissana Khoothiam⁴, Hans Bäuemler⁵, Nat Na-Ek^{6

7}

Affiliations

¹ Division of Biochemistry, School of Medical Sciences, University of Phayao, Phayao 56000, Thailand.
² Division of Pharmaceutical Sciences, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao 56000, Thailand.
³ Unit of Excellence Technologies for Natural Products and Herbs, School of Pharmaceutical Sciences, University of Phayao, Phayao 56000, Thailand.
⁴ Division of Microbiology, School of Medical Sciences, University of Phayao, Phayao 56000, Thailand.
⁵ Institute of Transfusion Medicine, Center of Tumor Medicine, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
⁶ Division of Pharmacy Practice, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao 56000, Thailand.
⁷ Pharmacoepidemiology, Social and Administrative Pharmacy (P-SAP) Research Unit, School of Pharmaceutical Sciences, University of Phayao, Phayao 56000, Thailand.

Abstract

Background: The efficacy and safety of nanoparticle albumin-bound paclitaxel (nab-paclitaxel) in advanced non-small cell lung cancer (NSCLC) have yielded inconsistent findings.

Materials and methods: We conducted a systematic review and meta-analysis, including comparative and noncomparative trials and cohort studies, to assess the efficacy and safety of nab-paclitaxel in advanced NSCLC. The search covered PubMed, CENTRAL, Scopus, and ClinicalTrials.gov until October 2022. Efficacy outcomes (OR, PR, progressive disease, OS, and PFS) and safety outcomes (neutropenia, leukopenia, thrombocytopenia, anemia, and sensory neuropathy) were analyzed.

Results: Our meta-analysis included data from 35 studies (9 RCTs, 2 cohort studies, and 24 noncomparative studies). Nab-paclitaxel significantly improved OR rate (RR_RCT 1.35 [95% CI 1.19, 1.53], I² = 36.6%; RR_cohort 1.67 [95% CI 1.30, 2.14], I² = 4.3%) and PR rate (RR_RCT 1.34 [95% CI 1.18, 1.53], I² = 38.8%; RR_cohort 1.59 [95% CI 1.22, 2.07], I² = 19.4%) compared to the control group. It further demonstrated more pronounced benefits in squamous cell carcinoma and as a second-line treatment. Pooled evidence from the RCTs also indicated improved OS (HR 0.90 [95% CI 0.81, 0.99], I² = 9.2%) and PFS (HR 0.84 [95% CI 0.76, 0.93], I² = 14.5%) However, evidence on the reduction of adverse events with nab-paclitaxel treatment was insufficient, and biases in study selection and detection may have influenced the results.

Conclusions: Nab-paclitaxel enhances OR, PR, PFS, and marginally improves OS in advanced NSCLC, particularly in patients with prior chemotherapy. Further research is needed to establish its safety advantages.

Keywords: Cohort study; Meta-analysis; Nanoparticle albumin-bound paclitaxel; Non-small cell lung cancer; Noncomparative study; Randomized controlled trial.