Paclitaxel is one of the most active agents in the treatment of ovarian carcinoma. Novel agents such as abraxane are solvent free and currently being evaluated to potentially avoid certain patient side effects. Abraxane is an albumin-stabilised nanoparticle formulation of paclitaxel designed to overcome various insolubility problems encountered with paclitaxel. This nano-technology eliminates the need for toxic solvents like cremophor, which limits the dose of paclitaxel that can be administered and hence affect overall drug efficacy. Cremophor is also know to cause various types of allergic reactions in patients who receive paclitaxel. Albumin receptor-mediated paclitaxel-transport mechanism is analogous to the opening of a ‘trapdoor’ on the endothelial cell wall within blood vessels. This facilitates easy passage of abraxane from the bloodstream via the blood vessels to the underlying tumour tissue. A study showed that Abraxane causes few allergic reactions in ovarian cancer patients. More recently, two studies were presented at the 43rd Annual Meeting of the American Society of Clinical Oncology (ASCO) held June 2 – 5, 2007 in Chicago. The first study titled “An open-label, Phase II trial of nab-paclitaxel, carboplatin and bevacizumab in first-line patients with advanced non-squamous non-small cell lung cancer (NSCLC)” (Abstract number 7610) was a randomized, open-label Phase II of nab-paclitaxel dosed every three weeks in combination with carboplatin and bevacizumab in 50 patients with advanced non-squamous NSCLC. The primary end point of the study was response rate based on Response Evaluation Criteria in Solid Tumors (RECIST) criteria. The other study titled “Results of a Phase II evaluation of nab-paclitaxel in platinum-sensitive patients with recurrent ovarian, peritoneal or fallopian tube cancer” (Abstract number 5525) was an open level Phase II study to evaluate single agent nab- paclitaxel in a platinum-sensitive patient population. Both studies demonstrated ABRAXANE’s activity and tolerability as a single agent for ovarian cancer. No phase III studies have yet been iniitated as per clinicaltrials.gov. As such, it has not been demonstrated to be as effective as established alternatives. There are no studies in resistant or multiply treated patients.
NCCN does recommend it for salvage therapy but the most recent Alberta guideline does not.
Micha JP, ET AL, Abraxane in the treatment of ovarian cancer: the absence of hypersensitivity reactions. : Gynecol Oncol. 2006 Feb;100(2):437-8. Epub 2005 Oct
Abraxane, Prescribing information
NCCN.ORG, Ovarian Cancer 2912
Alberta Provincial Gynecologic Oncology Tumour Team. Epithelial ovarian, fallopian tube, and primary peritoneal cancer. Edmonton (Alberta): Alberta Health Services, Cancer Care; 2010 Jul. 19 p. (Clinical practice guideline; no. GYNE-005). [104 references]