Nab-paclitaxel for the treatment of triple-negative breast cancer: Rationale, clinical data and future perspectives

• Chemotherapy is the mainstay treatment for TNBC but long-term outcomes remain poor.
• Nab-paclitaxel, a novel form of paclitaxel, has demonstrated superior efficacy in EBC and MBC.
• Emerging evidence suggests nab-paclitaxel may be particularly effective in TNBC.
• There’s a strong rationale and impressive early data for nab-paclitaxel/immunotherapy in TNBC.
• Evaluating agents based on therapeutic targets in TNBC subgroups may further improve outcomes.

Triple-negative breast cancer (TNBC) accounts for ∼10–20% of breast cancers and is associated with relatively poor prognosis, earlier disease recurrence and higher number of visceral metastases. Despite an increasing understanding of the molecular heterogeneity of TNBC, clinical trials of targeted agents have thus far been disappointing; chemotherapy, in particular with anthracycline and taxanes, remains the backbone medical management for both early and metastatic TNBC. Nab-paclitaxel is a solvent-free, albumin-bound, nanoparticle formulation of paclitaxel and represents a novel formulation of an established, effective chemotherapeutic agent. Nab-paclitaxel has been specifically designed to overcome the limitations of conventional taxane formulations, including the barriers to effective drug delivery of highly lipophilic agents. It has shown significant efficacy and better tolerability than conventional taxanes in metastatic breast cancer and is approved for use in this setting. Increasing evidence suggests that nab-paclitaxel is effective in patients with more aggressive tumours, as seen in TNBC. Indeed, results of Phase II/III studies indicate that nab-paclitaxel may be effective as neoadjuvant treatment of TNBC. This article reviews the rationale and evidence supporting a role for nab-paclitaxel in the treatment of TNBC, including ongoing studies such as ADAPT-TN and tnAcity. In addition, the article reviews ongoing research into targeted therapies and immuno-oncology for the treatment of TNBC, and explores the potential role, current evidence and ongoing studies of nab-paclitaxel as the chemotherapy partner in combination with immunotherapy, where the unique properties of this taxane, including the lack of requirement for steroid pre-medication, may present an advantage.