What type of study is this?

This is a Systematic Review study (also classified as: Meta-Analysis, RCT).

August 18, 2025Open Access

Efficacy of albumin-bound paclitaxel versus paclitaxel in esophageal cancer: a systematic review and meta-analysis

Key Points

Albumin-bound paclitaxel significantly improves objective response rate and disease control rate compared to paclitaxel.
Meta-analysis revealed ORR of 1.67 and DCR of 1.69 for albumin-bound paclitaxel, both with p < 0.001.
Assessment included 11 randomized controlled trials across various databases, ensuring comprehensive review of existing literature.
Lower incidences of adverse reactions like diarrhea and nausea support albumin-bound paclitaxel's safer profile in treatment.

Abstract

Objective To systematically evaluate the efficacy and safety of albumin-bound paclitaxel and paclitaxel in the treatment of esophageal cancer. Methods Seven databases (PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Data, China Science and Technology Journal Database, and China Biology Medicine disc) were searched for randomized controlled trials (RCTs) of albumin-bound paclitaxel and paclitaxel in the treatment of esophageal cancer. The search was conducted from database inception to February 2025. Literature quality was assessed using the Cochrane Risk of Bias Tool version 1 (RoB 1), and the systematic review and meta-analysis was performed using RevMan 5.4.1 and STATA18. Results Eleven RCTs were included. Meta-analysis demonstrated that albumin-bound paclitaxel significantly improved objective response rate ORR; relative risk (RR) = 1.67, 95% confidence interval (CI) [1.45, 1.92, p 0.001, I 2 = 0%] and disease control rate (DCR; RR = 1.69, 95% CI 1.43, 1.98, p 0.001, I 2 = 0%) compared to paclitaxel. It also showed superior improvements in serum tumor markers: cancer antigen 125 (CA125) mean difference (MD) = −1.69, 95% CI [−2.73, −0.65, p 0.001, I 2 = 83%], Carbohydrate antigen 19-9 (CA199) (MD = −2.12, 95% CI −3.39, −0.84, p = 0.001, I 2 = 85%), and carcinoembryonic antigen (CEA) (MD = −2.01, 95% CI −2.53, −1.50, p 0.001, I 2 = 99%), although Squamous Cell Carcinoma Antigen (SCC) improvement was non-significant (MD = −1.19, 95% CI −2.61, 0.24, p 0.001, I 2 = 100%). Regarding safety, albumin-bound paclitaxel had markedly lower incidences of diarrhea (RR = 0.49, 95% CI 0.33, 0.72, p = 0.003, I 2 = 0%), nausea/vomiting (RR = 0.61, 95% CI 0.46, 0.80, p 0.001, I 2 = 0%), thrombocytopenia (RR = 0.61, 95% CI 0.44, 0.85, p = 0.004, I 2 = 22%), and myalgia/arthralgia (RR = 0.45, 95% CI 0.22, 0.94, p = 0.03, I 2 = 0%), while neutropenia showed no significant difference (RR = 0.58, 95% CI 0.32, 1.03, p = 0.006, I 2 = 0%). Conclusion Compared to paclitaxel, albumin-bound paclitaxel (nab-paclitaxel) demonstrates superior efficacy in the treatment of esophageal cancer, with fewer adverse reactions such as diarrhea, thrombocytopenia, and musculoskeletal pain.

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