Hope S. Rugo, MD, professor of medicine and director of breast oncology and clinical trials education at the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, discusses a phase III randomized trial that compared the two new agents, nab-paclitaxel (Abraxane) and ixabepilone (Ixempra), to the standard weekly agent paclitaxel (Taxol) for patients with locally advanced or metastatic breast cancer.

The trial provided all three agents weekly for a three-week cycle followed by a one-week break. Rugo notes that this schedule for ixabepilone will no longer be used in practice, because of the observed increase in toxicities. However, the three-week schedule for nab-paclitaxel was effective.

This trial established that paclitaxel is an effective drug and performed as good or better than the newer and more expensive competitors examined on the trial, at the weekly dosing examined. Additionally, Rugo notes that less toxicity was observed with paclitaxel than the other two drugs.

Rugo notes that paclitaxel should remain the standard first-line therapy with nab-paclitaxel second-line for patients who have progressed. Nab-paclitaxel works well in the second-line setting because it does not require premedication with a steroid. Rugo notes that the standard dose for nab-paclitaxel should remain 100 mg/m²; the trial examined increasing the dose to 150 mg/m² but this resulted in increased toxicity without any additional benefits.

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