Second Opinion

I’m impressed with nab paclitaxel and find it easier to administer than paclitaxel.It doesn’t require premedication, we see fewer allergic reactions and patientsprefer it. In many cases we seek insurance preauthorization and, if we obtain it,that’s my choice. If not, I choose paclitaxel.Bill Gradishar published Phase III data comparing standard paclitaxel to nabpaclitaxel for patients with metastatic breast cancer and demonstrated that ahigher dose of paclitaxel could be administered with less hematologic toxicityand an improvement in response rate and time to disease progression with nabpaclitaxel (Gradishar 2005; [2.2]).2.1Phase III Trial of Weekly Paclitaxel Compared to Weekly NabPaclitaxel or Ixabepilone Combined with Bevacizumab as First- orSecond-Line Therapy for Locally Recurrent or Metastatic Breast CancerProtocol IDs: CALGB-40502, CTSU, NCT00785291; Target Accrual: 900EligibilityStage IIIB not amenable to local therapy or Stage IV breast cancer; no preexisting peripheralneuropathy ≥ Grade II; no recent history of abdominal fistula or intra-abdominal abscess, gastrointestinalperforation or significant bleeding; no clinically significant cardiovascular disease;no history of stroke or TIA within previous six months; no CNS metastasesWeekly paclitaxel + bevacizumabRWeekly nab paclitaxel + bevacizumabWeekly ixabepilone + bevacizumabSOURCE: www.clinicaltrials.gov. Accessed February 24, 2009.2.2Phase III Randomized Trial Comparing Nab Paclitaxel(Every Three Weeks) to Paclitaxel (Every Three Weeks)for Women with Metastatic Breast CancerNab paclitaxel 1 Paclitaxel 2Parameter (n = 229) (n = 225) p-valueComplete and partial responsesAll patients 33% 19% 0.001First-line therapy 42% 27% 0.029Second-line or greater therapy 27% 13% 0.006Median time to tumor progression 23.0 weeks 16.9 weeks 0.006Median survivalAll patients 65.0 weeks 55.7 weeks 0.374Second-line or greater therapy 56.4 weeks 46.7 weeks 0.0241Nab paclitaxel at 260 mg/m 2 every three weeks without premedication2Paclitaxel at 175 mg/m 2 every three weeks with premedicationSOURCE: Gradishar WJ et al. J Clin Oncol 2005;23(31):7794-803. Abstract7