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

The efficacy and safety of nanoparticle albumin-bound paclitaxel (nab-paclitaxel) in advanced non-small cell lung cancer (NSCLC) have yielded inconsistent findings. 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. Our meta-analysis included data from 35 studies (9 RCTs, 2 cohort studies, and 24 noncomparative studies). Nab-paclitaxel significantly improved OR rate (RRRCT 1.35 [95% CI 1.19, 1.53], I2 = 36.6%; RRcohort 1.67 [95% CI 1.30, 2.14], I2 = 4.3%) and PR rate (RRRCT 1.34 [95% CI 1.18, 1.53], I2 = 38.8%; RRcohort 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. 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.