Real-world effectiveness of polymeric micellar paclitaxel versus albumin-bound paclitaxel in advanced esophageal squamous cell carcinoma: a retrospective study

Aims To compare polymeric micellar paclitaxel (pm-PTX) and albumin-bound paclitaxel (nab-PTX) in first-line immunochemotherapy for advanced esophageal squamous cell carcinoma (ESCC).Patients and method We included 109 patients in efficacy and cost-effectiveness analyses (pm-PTX, n = 51; nab-PTX, n = 58) and 112 treatment initiators in safety analyses (pm-PTX, n = 52; nab-PTX, n = 60). Progression-free and overall survival (PFS and OS) were analyzed using Kaplan–Meier and overlap-weighted Cox models.Results Median PFS was 10.2 versus 16.7 months (pm-PTX vs nab-PTX, log-rank p = 0.148). After overlap weighting, no significant differences were observed in PFS (hazard ratio [HR], 0.83; 95% confidence interval [CI], 0.43–1.59; p = 0.574) or OS (HR, 1.32; 95% CI, 0.55–3.13; p = 0.536). OS analysis was immature. Response and disease control rates did not differ significantly. Any-grade gastrointestinal reactions, cough, and grade 3–4 anemia and neutropenia were more frequent with pm-PTX (40.4% vs. 10.0%, 11.5% vs. 0.0%, 7.7% vs. 0.0%, and 28.8% vs. 13.3%; p < 0.001, 0.009, 0.044, and 0.060, respectively). Taxane costs were higher with pm-PTX under Chinese pricing.Conclusions No statistically significant efficacy differences were observed. Both regimens showed manageable but distinct safety profiles; nab-PTX may be economically favorable.