A meta-analysis of the incidence and risk of skin toxicity with nab-paclitaxel and paclitaxel in cancer treatment

Background: 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. Methods: 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.Results: 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]).Conclusion: 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.