• 799 patients treated on the trial, 98% of whom also received Bev: PFS: Pac (10.6 months); nab Pac (9.2 months); Ixa (7.6 months).
• Hematologic toxicity greater with nab Pac; sensory neuropathy greater with nab Pac and Ixa.

This massive Phase III cooperative group study was widely viewed as establishing the lack of clinical benefit from nab paclitaxel and ixabepilone, but although ixabepilone clearly underperformed in both efficacy and tolerability, nab might be another story. The nab picture has always been clouded by financial considerations, and although these are critical to consider, it is also important to examine what’s best for patients from a purely clinical risk-benefit perspective. In this study, nab was associated with more toxicity than paclitaxel, but it was also administered at a 66% higher dose (150 mg/m²). The efficacy of these formulations was not statistically different, and it’s difficult to say whether nab would be any different from paclitaxel on a mg-for-mg basis except for the shorter infusion time and lack of need for corticosteroids. Regardless of the immediate clinical implications of this study, perhaps the most important data are yet to come as preplanned translational work will hopefully soon shed light on predictors of response to specific chemotherapy agents and to bevacizumab.