Can nab-paclitaxel treat pancreatic cancer?

Paclitaxel for injection (albumin-bound) (nanoparticlealbumin-boundpaclitaxel, nab-P; Abraxane?) is a new generation of paclitaxel developed by Abraxis in the United States. It is currently approved by the FDA for the treatment of metastatic breast cancer that has failed combined chemotherapy or breast cancer that relapses within 6 months after adjuvant chemotherapy; and the first-line treatment of locally advanced or metastatic non-small cell lung cancer. Nab-P uses albumin as a carrier for paclitaxel, removing the toxic cosolvent of traditional taxanes, which can safely increase the dose of paclitaxel, shorten the infusion time, and does not require pretreatment to prevent allergic reactions before medication. In addition, Nab-P can promote the drug to accumulate more in tumor tissues through the special transport pathway of albumin (Gp60-caveolin-SPARC protein) and by binding to the cysteine-rich acidic secretory protein (SPARC) in tumor tissues, while less distributed in normal tissues, which can increase the efficacy of chemotherapy while reducing toxicity. Studies have found that most pancreatic cancer tissues have high expression of SPARC protein, which can specifically bind to nab-P, suggesting that nab-P may become a new option for pancreatic cancer treatment.
A phase I/II study conducted by VonHoff et al. on the first-line treatment of advanced pancreatic cancer with gemcitabine combined with nab-P has brought new hope. The MTD determined in this study is gemcitabine 1000mg/m2 combined with nab-P 125mg/m2, administered on days 1, 8 and 15, with a course of 28 days. At this dose (44 patients), the efficacy rate can reach 48%, and the median OS is 12.2 months. The results of preclinical animal experiments suggest that the efficacy may be related to the elimination of tumor matrix in addition to the anti-tumor activity of nab-P itself. Since pancreatic cancer is a tumor with low vascular proliferation and rich fibrous matrix, the dense stroma may be a key factor that hinders the cytotoxic effect of chemotherapy drugs. Based on the gratifying efficacy achieved by the above study by VonHoff et al., and the results of the phase III clinical trial will be reported at the ASCO meeting in January 2013, the overall survival is positive, suggesting that Nab-P combined with gemcitabine may be a new choice for patients with advanced pancreatic cancer.