Paclitaxel

Indications

Cancer

Ovarian Carcinoma: Paxel is indicated as first-line and subsequent therapy for the treatment of advanced carcinoma of the ovary. As first-line therapy, Paxel is indicated in combination with cisplatin. Breast Carcinoma: Paxel is indicated for the adjuvant treatment of node-positive breast cancer, given sequentially after standard doxorubicin-containing combination chemotherapy. Paxel is indicated for the treatment of breast cancer after failure of combination chemotherapy for metastatic disease, or relapse within 6 months of adjuvant chemotherapy. Prior therapy should have included an anthracycline unless clinically contraindicated. Paxel is indicated for the first-line therapy of advanced or metastatic breast cancer, either in combination with an anthracycline in patients for whom anthracycline therapy is suitable, or in combination with trastuzumab in patients whose tumours overexpress HER2 at a 2+ or 3+ level as determined by immunohistochemistry. Gemcitabine, in combination with Paxel, is indicated in the treatment of patients with unresectable, locally recurrent or metastatic breast cancer who have relapsed following adjuvant or neoadjuvant chemotherapy. Prior chemotherapy should have included an anthracycline unless clinically contraindicated. Paxel is indicated for the treatment of metastatic cancer of the breast, in combination with trastuzumab, in patients who have tumours that overexpress HER2 and who have not received previous chemotherapy for their metastatic disease. Non-Small Cell Lung Carcinoma: Paxel, in combination with cisplatin, is indicated for the first-line treatment of non-small cell lung cancer in patients who are not candidates for potentially curative surgery and/or radiation therapy. Kaposi's Sarcoma: Paxel is indicated for the second-line treatment of AIDS-related Kaposi's sarcoma. Gastric Carcinoma: Paxel is indicated for the treatment of gastric carcinoma.

⚠️ Always consult a registered physician before taking any medicine.

Pharmacology

Paclitaxel is a novel anti-microtubule agent. It promotes the assembly of microtubules from tubulin dimers and stabilizes microtubules by preventing depolymerization. This stability blocks the normal dynamic reorganization of the microtubule network, a process the cell depends on for vital interphase and mitotic functions. Paclitaxel also induces abnormal arrays or "bundles" of microtubules throughout the cell cycle, along with multiple asters of microtubules during mitosis. After intravenous administration, plasma concentrations of paclitaxel decline in a biphasic manner. The initial rapid decline reflects distribution into the peripheral compartment together with elimination of the drug, while the later, slower phase is due in part to a relatively slow efflux of paclitaxel back out of that peripheral compartment.

Pregnancy & Breastfeeding

Pregnancy Category D. There isn't enough evidence from human studies to confirm the effects of paclitaxel in pregnancy, but like other cytotoxic drugs, it may harm the unborn baby if taken while pregnant. Paclitaxel should not be used while breastfeeding.

⚠️ Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.

Dosage Reference

⚠️ Reference ranges from official sources only. Consult your doctor for personalized dosing.

Adults: All patients should be given premedication before paclitaxel is started, to prevent severe hypersensitivity reactions. The premedication may include dexamethasone 20 mg by mouth (PO), taken about 12 and 6 hours before paclitaxel. Diphenhydramine (or an equivalent) 50 mg IV is given 30 to 60 minutes before paclitaxel, and cimetidine (300 mg) or ranitidine (50 mg) IV is given 30 to 60 minutes before paclitaxel too. First-line treatment of ovarian cancer: Other medicine regimens with paclitaxel are still being studied, but a combination of paclitaxel and cisplatin is the recommended choice. Two dosages are used, depending on how long the infusion runs. In the first, 175 mg/m2 of paclitaxel is given as an intravenous infusion over three hours, followed by 75 mg/m2 of cisplatin, and the treatment is repeated every 3 weeks. In the second, 135 mg/m2 of paclitaxel is given as an intravenous infusion over 24 hours, followed by 75 mg/m2 of cisplatin, again repeated every 3 weeks. Second-line treatment of ovarian cancer: The recommended dose is 175 mg/m2 given over 3 hours, with a 3-week gap between courses. Adjuvant chemotherapy in breast carcinoma: The recommended dose is 175 mg/m2 given over 3 hours every 3 weeks for four courses, after AC therapy. First-line chemotherapy of breast carcinoma: When paclitaxel is used with doxorubicin (50 mg/m2), paclitaxel is given 24 hours after the doxorubicin. The recommended dose is 220 mg/m2 given intravenously over 3 hours, with a 3-week gap between courses. When paclitaxel is used with trastuzumab, the recommended dose is 175 mg/m2 given intravenously over 3 hours, with a 3-week gap between courses. The paclitaxel infusion can start the day after the first trastuzumab dose, or straight after later trastuzumab doses if the previous one was well tolerated. Second-line chemotherapy of breast carcinoma: The recommended dose is 175 mg/m2 given over 3 hours, with a 3-week gap between courses. Advanced non-small-cell lung cancer: The recommended dose is 175 mg/m2 given over 3 hours, followed by 80 mg/m2 of cisplatin, with a 3-week gap between courses. Treatment of AIDS-related KS: The recommended dose is 100 mg/m2 given as a 3-hour intravenous infusion every two weeks. Dose adjustment: Later doses should be based on how well each patient tolerates the medicine. Do not give paclitaxel again until the neutrophil count is above 1.5 x 109/1 (above 1 x 109/1 for KS patients) and the platelet count is above 100 x 109/1 (above 75 x 109/1 for KS patients).

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Indications

Pharmacology

Pregnancy & Breastfeeding

Dosage Reference

Side Effects & Interactions

Side Effects

Key Interactions