nab-paclitaxel + epirubicin + cyclophosphamide

The combination of nab-paclitaxel + epirubicin + cyclophosphamide is a neoadjuvant chemotherapy regimen used primarily for breast cancer treatment. This regimen typically involves sequential administration of nab-paclitaxel followed by the combination of epirubicin and cyclophosphamide (EC). ## Drug Information Nab-paclitaxel (also known as nanoparticle albumin-bound paclitaxel) is a novel solvent-free formulation of paclitaxel with an improved safety profile compared to conventional paclitaxel. It doesn't require steroid premedication to prevent allergic reactions, which can be beneficial when combining with immunotherapies[6]. The EC component consists of epirubicin (an anthracycline) and cyclophosphamide (an alkylating agent). ## Clinical Applications This combination has been studied extensively in neoadjuvant settings for breast cancer, particularly for triple-negative breast cancer (TNBC) and HER2-positive breast cancer. Clinical trials have shown promising anti-tumor activity with acceptable tolerability profiles[1][2]. In one phase II study, patients with TNBC received nab-paclitaxel 125 mg/m² weekly for 12 weeks, followed by dose-dense EC (epirubicin 90 mg/m²; cyclophosphamide 600 mg/m²) every 2 weeks for 4 cycles. This regimen achieved a total pathological complete response (tpCR) rate of 43.1%[1]. Another study used a biweekly dose-dense approach with nab-paclitaxel (260 mg/m²) followed by epirubicin (90 mg/m²) and cyclophosphamide (600 mg/m²) with pegfilgrastim support. This regimen was particularly effective in triple-negative disease, with a pathological complete response rate of 38.5% in TNBC patients compared to 10.3% in luminal disease patients[2]. ## Dosing Variations Several dosing schedules have been studied: - Weekly nab-paclitaxel (125-150 mg/m²) for 12 weeks followed by EC[1][7] - Three-weekly nab-paclitaxel (260 mg/m²) followed by EC[2][6] - Weekly nab-paclitaxel (80 mg/m²) for 12 cycles after EC[4] ## Safety Profile The most common adverse events associated with this regimen include: - Alopecia - Myalgia (14.5% grade 3-4)[2] - Fatigue (12.7% grade 3-4)[2] - Elevated transaminase levels (9.1% grade 3-4)[2] - Peripheral neuropathy (typically grade 1-2)[7] Grade 3 or higher adverse events occurred in 63.6% of patients in one study, but no treatment-related surgical delays or deaths were reported[1]. The addition of pegfilgrastim support has been shown to reduce the incidence of febrile neutropenia[2]. This combination represents an important treatment option in the neoadjuvant setting for breast cancer, with particular efficacy in aggressive subtypes like triple-negative breast cancer.

Other names

nab-paclitaxel followed by ECnab-paclitaxel/epirubicin/cyclophosphamide