Nab-paclitaxel or Paclitaxel Treatment for Relapsed Small Cell Lung Cancer: A Single-arm Meta-analysis

Relapsed small cell lung cancer (SCLC) treatment has limited evidence-based options. Solvent-based paclitaxel (PTX) and albumin-bound nanoparticle paclitaxel (nab-PTX) are commonly prescribed though never comprehensively quantified.

A systematic review and single-arm meta-analysis was conducted (PROSPERO Registration: CRD42024592475). PubMed, Web of Science, Cochrane Library, and EMBASE were searched for interventional or observational studies reporting PTX or nab-PTX monotherapy in relapsed SCLC. Primary outcomes were the pooled 3-month progression-free survival rate (PFS), 6-month overall survival rate (OS), objective response rate (ORR), and disease-control rate (DCR). Random-effects models generated pooled estimates; prespecified subgroup analyses compared Asian versus Euro-American cohorts, and PTX versus nab-PTX treatment.

Fifteen studies (11 retrospective and 4 prospective) comprising 631 patients met the eligibility criteria of the study. Pooled efficacy estimates were: 3-month PFS 39% [95% confidence interval (CI)=28-50%, I²=84%], 6-month OS 46% (95%CI=32-61%, I²=91%), ORR 16% (95%CI=12-21%, I²=51%) and DCR 51% (95%CI=41-61%, I²=83%). Grade 3 or higher toxicities were infrequent - neutropenia 18% (95%CI=11-25%, I²=89%) and peripheral neuropathy 2% (95%CI=0-3%, I²=0%). Among 45 patients with pre-existing interstitial lung disease (ILD), treatment-related ILD exacerbations were 17% (95%CI=6-28%, I²=0%). Asian cohorts demonstrated greater neutropenia (26% vs. 5%) than Euro-American cohorts. Efficacy and safety were similar between PTX and nab-PTX monotherapy.

Despite substantial heterogeneity, paclitaxel-based regimens demonstrated modest but clinically meaningful activity with generally favorable safety profile in relapsed SCLC, highlighting them as a pragmatic salvage option. In patients with ILD, their use warrants caution due to the risk of ILD exacerbation.