Meta Analysis Of The Efficacy And Safety Of Albumin-Bound Paclitaxel And Paclitaxel (or Docetaxel) In Neoadjuvant Chemotherapy For Breast Cancer

Objective: To evaluate the clinical efficacy and side effects of albumin-bound paclitaxel and paclitaxel(or docetaxel)in neoadjuvant chemotherapy for breast cancer.Methods: The data of PubMed,EMBASE,WanFang,CNKI and CBM were searched for the clinical study of albumin-bound paclitaxel versus paclitaxel(or docetaxel)in the treatment of breast cancer neoadjuvant chemotherapy from foundation to December 25,2019.The literatures that met the inclusion criteria were analyzed by meta using Rev Man5.3 software,and the ratio of PCR rate and side effect rate after neoadjuvant chemotherapy was calculated to evaluate the clinical efficacy and safety of albumin-bound paclitaxel in breast cancer neoadjuvant chemotherapy by(OR).Q-test and I~2 statistics were used to assess the heterogeneity between studies.Results: After close screening,irrelevant articles,review articles,case reports,non-clinical studies and other literatures were excluded,and 8 related literatures with a total of 2508 patients were selected.The results showed that there was significant difference in PCR rate(ypT0/is ypN0)between albumin-bound paclitaxel group and paclitaxel(or docetaxel)group(32.3%vs24.3%,OR=1.51,95%CI: 1.26～1.81,I~2=18%,P<0.00001).There was a statistically significant difference in PCR rate(ypT0 ypN0)between the albumin-bound paclitaxel group and the paclitaxel(or docetaxel)group(33.5%vs24.3%,OR=1.60,95% CI: 1.28～2.00,I ~2= 0%,P <0.0001).Subgroup analysis: albumin-bound paclitaxel had a higher PCR rate in triple negative breast cancer subgroup(42.8%vs28.0%,OR=1.89,95%CI: 1.36～2.62,I~2=45%,P=0.0001),the difference was statistically significant;higher PCR rate was also obtained in Ki67 ≥ 20% subgroup(41.3%vs23.6%,OR=2.24,95%CI: 1.71～2.94,I~2=0%,P<0.00001),the difference was statistically significant.In the her-2 positive subgroup,there was no significant difference in PCR rate(60.4%vs54.1%,OR=1.31,95%CI: 0.89～1.92,I~2=25%,P=0.17).In terms of safety,the albumin-bound paclitaxel group had a higher incidence of diarrhea(43.9%vs37.9%,OR =1.31,95% CI :1.05～1.62,I~2=0%,P=0.02)and grade 3-4peripheral sensory neuropathy(16.8%/8.5%,OR =2.18,95% CI :1.99～3.95,I~2=41%,P﹤0.00001),and the difference was statistically significant.There was no significant difference in the incidence of adverse reactions such as grade 3-4 nausea and vomiting(11.0%/11.3%,OR =0.99,95% CI :0.67～1.47,I~2=0%,P=0.98),grade 3-4granulocytopenia(54.0%vs56.9%,OR =0.88,95% CI :0.72～1.08,I~2=20%,P=0.23)and thrombocytopenia(22.3%/22.8%,OR =0.97,95% CI :0.75～1.26,I~2=0%,P=0.82).Conclusion:Albumin-bound paclitaxel has a higher PCR rate in neoadjuvant therapy of breast cancer,but also has a higher incidence of diarrhea and grade 3-4 peripheral sensory neuropathy.