Li Hong-Bo, Wang Wen-Hui, Wang Zhi-Yong
Jinhua People's Hospital Jinhua 321000, Zhejiang, China.
Department of Breast Surgery, Affiliated Hospital of Beihua University Jilin 132000, Jilin, China.
Am J Transl Res. 2023 Jun 15;15(6):4279-4290. eCollection 2023.
Skin toxicity of varying severity occurs mostly during various courses of chemotherapy. In clinical trials and practice, we have found that both nab-paclitaxel and paclitaxel cause side effects such as rash and pruritus. To further clarify the incidence of rash and pruritus in both, we conducted the present study by a systematic evaluation, the results of which can be used to guide clinical dosing choices.
An electrical search was performed on randomized controlled research trials of nab-paclitaxel and paclitaxel for the treatment of malignancies. The necessary data were extracted, integrated, and analyzed from the included studies by systematic evaluation and meta-analysis, depending on the study design. Further subgroup analyses were performed to explore the incidence of rash and pruritus in nab-paclitaxel and paclitaxel.
Eleven studies with a total of 971 patients with malignancy were included. Four studies were application of single-agent nab-paclitaxel compared with paclitaxel, and seven studies were comparative chemotherapy drug combinations. The incidence of rash was higher in all grades of nab-paclitaxel than that in paclitaxel (OR=1.39, CI 95% [1.18-1.62]); the incidence of rash was higher in lower grades of paclitaxel than that in solvent-based paclitaxel (OR=1.31, CI 95% [1.11-1.53]); the incidence of rash was higher in all grades in the single-agent application comparison. The incidence of rash was higher in nab-paclitaxel than that in paclitaxel (OR=1.81, CI 95% [1.26-2.59]); there was no significant difference in the incidence of pruritus between nab-paclitaxel and paclitaxel (OR=1.19, CI 95% [0.88-1.61]).
In comparison with paclitaxel, nab-paclitaxel significantly increased the risk of a teething rash. There was a significant risk correlation between nab-paclitaxel and teething rash. Early prevention, identification, and treatment of rash could significantly improve patient's quality of life and optimize their clinical survival.
不同程度的皮肤毒性大多发生在化疗的各个疗程中。在临床试验和实践中，我们发现纳米白蛋白结合型紫杉醇和紫杉醇都会引起皮疹和瘙痒等副作用。为进一步明确两者皮疹和瘙痒的发生率，我们通过系统评价开展了本研究，其结果可用于指导临床给药选择。
对纳米白蛋白结合型紫杉醇和紫杉醇治疗恶性肿瘤的随机对照研究试验进行电子检索。根据研究设计，通过系统评价和荟萃分析从纳入研究中提取、整合并分析必要数据。进行进一步的亚组分析以探讨纳米白蛋白结合型紫杉醇和紫杉醇皮疹及瘙痒的发生率。
纳入11项研究，共971例恶性肿瘤患者。4项研究为单药纳米白蛋白结合型紫杉醇与紫杉醇的应用比较，7项研究为化疗药物联合方案比较。纳米白蛋白结合型紫杉醇各等级皮疹发生率均高于紫杉醇（OR = 1.39，95%CI [1.18 - 1.62]）；紫杉醇低等级皮疹发生率高于溶剂型紫杉醇（OR = 1.31，95%CI [1.11 - 1.53]）；单药应用比较中各等级皮疹发生率均较高。纳米白蛋白结合型紫杉醇皮疹发生率高于紫杉醇（OR = 1.81，95%CI [1.26 - 2.59]）；纳米白蛋白结合型紫杉醇与紫杉醇瘙痒发生率无显著差异（OR = 1.19，95%CI [0.88 - 1.61]）。
与紫杉醇相比，纳米白蛋白结合型紫杉醇显著增加了出牙疹的风险。纳米白蛋白结合型紫杉醇与出牙疹之间存在显著的风险相关性。早期预防、识别和治疗皮疹可显著改善患者生活质量并优化其临床生存期。
