Nanoparticle albumin-bound paclitaxel (nab-Paclitaxel): Bridging pharmacology and translational medicine in breast cancer.

Nanoparticle albumin-bound paclitaxel (nab-paclitaxel) represents a significant advancement in breast cancer therapy by enhancing drug delivery and minimizing solvent-related toxicity. Utilizing albumin-mediated transcytosis, nab-paclitaxel achieves superior intratumoral accumulation while eliminating hypersensitivity reactions linked to solvent-based taxanes. Clinical trials in metastatic breast cancer have demonstrated higher response rates and improved tolerability compared with conventional paclitaxel, especially in HER2-negative and triple-negative subtypes. In neoadjuvant settings, nab-paclitaxel-based regimens yield higher pCR rates and exhibit synergistic efficacy when combined with carboplatin, anthracyclines, or immune checkpoint inhibitors. Safety analyses show a favorable profile with reduced myelosuppression but an increased risk of peripheral neuropathy in certain populations. Additionally, nab-paclitaxel has been effectively incorporated into immunotherapy regimens for TNBC and HER2-targeted strategies in HER2-positive disease. Pharmacokinetic studies reveal improved tissue distribution and higher unbound paclitaxel exposure compared to solvent-based formulations. Overall, nab-paclitaxel offers distinct therapeutic advantages in terms of efficacy, safety, and tumor targeting, representing a major step forward in overcoming resistance and optimizing breast cancer treatment.