Background Nanoparticle albumin-bound paclitaxel (nab-paclitaxel) is a protein-bound derivative of paclitaxel with improved solubility over conventional paclitaxel. This allows a shorter infusion time, reduces the risk of hypersensitivity reactions and eliminates the need for premedication with dexamethasone, dexchlorpheniramine and ranitidine.

Purpose The aim was to determine the off-label use and evaluate the toxicity of, and tolerance towards, nab-paclitaxel in patients with metastatic pancreatic adenocarcinoma.

Materials and methods Retrospective observational study of two patients with metastatic pancreatic adenocarcinoma treated with nab-paclitaxel. Data were collected from the cytostatics software Oncofarm, patient histories and record of tests performed with Omega3MIL software.

Results Patient 1: A seventy-six year-old woman, diagnosed with pancreatic adenocarcinoma cT3cN0M1 (hepatic cells) in February 2011, started first-line treatment with gemcitabine-oxaliplatin x 5 cycles. In April 2011, biochemical and hepatic progression, second-line treatment with capecitabine-erlotinib x 3 cycles. In July 2011, biochemical and clinical progression, third-line treatment with nab-paclitaxel 100 mg/m² and gemcitabine 800 mg/m² days 1, 8 and 15 every 4 weeks. Received 3 cycles in total until progression of the disease in October 2011. The patient developed second-degree lymphopenia and anaemia. Patient 2: A fifty-eight year-old man, diagnosed with pancreatic adenocarcinoma pT3pN1(7/19)M1 (lung, retroperitoneal ganglion and hepatic cells). Head-pancreaticoduodenectomy was performed. In December 2009, first-line treatment with gemcitabine-oxaliplatin x12 cycles followed by gemcitabine monotherapy x11 cycles. In December 2010, progression in lungs and liver. Started second-line treatment with capecitabine-erlotinib x5 cycles. In May 2011, pulmonary and hepatic progression. Started third-line treatment with nab-paclitaxel 100 mg/m² days 1, 8 and 15 every 4 weeks. The patient had received 5 cycles and was continuing treatment at the time of writing. First-degree anaemia was observed.

Conclusions The patients tolerated the treatment well. They did not develop any severe adverse reactions associated with nab-paclitaxel. Peripheral neuropathy, neutropenia and hypersensitivity reactions were not observed. No doses of the drug needed to be omitted or postponed.