Taxol

Tax·ol (tksôl)

A trademark for the drug paclitaxel.

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Taxol,

trademark for an anticancer drug (paclitaxel).

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Taxol [tak´sol]

trademark for a preparation of paclitaxel, an antineoplastic agent.

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paclitaxel Warning - Hazardous drug!

Onxol, Paxene (UK), Taxol

Pharmacologic class: Antimicrotubule agent

Therapeutic class: Antineoplastic

Pregnancy risk category D

FDA Boxed Warning

• Give injection under supervision of physician experienced in use of cancer chemotherapy, in facility with adequate diagnostic and treatment resources.
• Anaphylaxis and severe hypersensitivity reactions may occur despite premedication. All patients should be pretreated with corticosteroids, diphenhydramine, and histamine₂ antagonists. Don't give drug to patients who've had previous severe reactions.
• Don't administer drug to patients with solid tumors whose baseline neutrophil counts are below 1,500 cells/mm³ or to patients with AIDS-related Kaposi's sarcoma whose baseline neutrophil counts are below 1,000 cells/mm³. To monitor for bone marrow suppression, obtain frequent peripheral blood cell counts on all patients.
• Albumin form of drug may substantially affect drug's functional properties. Don't substitute for or use with other paclitaxel forms.

Action

Stabilizes cellular microtubules to prevent depolymerization. This action inhibits microtubule network (essential for vital interphase and mitotic cellular functions) and induces abnormal microtubule arrays or bundles throughout cell cycle and during mitosis.

Availability

Concentrate for injection: 30 mg/5-ml vial, 100 mg/16.7-ml vial, 300 mg/50-ml vial

⊘Indications and dosages

➣ Advanced ovarian cancer

Adults: As first-line therapy, 175 mg/m² I.V. over 3 hours q 3 weeks, or 135 mg/m² I.V. over 24 hours q 3 weeks, followed by cisplatin. After failure of first-line therapy, 135 mg/m² I.V. or 175 mg/m² I.V. over 3 hours q 3 weeks.

➣ Breast cancer after failure of combination chemotherapy

Adults: As adjuvant treatment for node-positive breast cancer, 175 mg/m² I.V. over 3 hours q 3 weeks for four courses given sequentially with doxorubicin combination chemotherapy. After chemotherapy failure for metastatic disease or relapse within 6 months of adjuvant therapy, 175 mg/m² I.V. over 3 hours q 3 weeks.

➣ Non-small-cell lung cancer

Adults: 135 mg/m² I.V. over 24 hours q 3 weeks, followed by cisplatin

➣ AIDS-related Kaposi's sarcoma

Adults: 135 mg/m² I.V. over 3 hours q 3 weeks, or 100 mg/m² I.V. over 3 hours q 2 weeks

Dosage adjustment

• Advanced human immunodeficiency virus infection (when used for Kaposi's sarcoma)

Off-label uses

• Advanced head and neck cancer
• Small-cell lung cancer
• Upper GI tract adenocarcinoma
• Non-Hodgkin's lymphoma
• Pancreatic cancer
• Polycystic kidney disease

Contraindications

• Hypersensitivity to drug or castor oil
• Solid tumors when baseline neutrophil count is below 1,500 cells/mm³
• AIDS-related Kaposi's sarcoma when baseline neutrophil count is below 1,000 cells/mm³

Precautions

Use cautiously in:
• severe hepatic impairment, active infection, decreased bone marrow reserve, chronic debilitating illness
• patients with childbearing potential
• breastfeeding patients (not recommended)
• children (safety not established).

Administration

☞ Follow facility protocol for handling chemotherapeutic drugs and preparing solutions.
• Dilute in dextrose 5% in water, normal saline solution, or dextrose 5% in lactated Ringer's solution per manufacturer's guidelines.
• Inspect solution for particles. Administer through polyethylene-lined administration set attached to 0.22-micron in-line filter.
• To prevent severe hypersensitivity reaction, premedicate with dexamethasone 20 mg 12 and 6 hours before infusion, as prescribed. Also give diphenhydramine 50 mg I.V., plus either cimetidine 300 mg or ranitidine 50 mg I.V. 30 to 60 minutes before paclitaxel.
☞ Keep epinephrine available. If severe hypersensitivity reaction occurs, stop infusion immediately and give epinephrine, I.V. fluids, and additional antihistamine and corticosteroid doses, as indicated and prescribed.

Route	Onset	Peak	Duration
I.V.	Unknown	Unknown	Unknown

Adverse reactions

CNS: peripheral neuropathy

CV: hypotension, hypertension, syncope, abnormal ECG, bradycardia, venous thrombosis

GI: nausea, vomiting, diarrhea, stomatitis, mucositis

Hematologic: anemia, leukopenia, neutropenia, bleeding, thrombocytopenia

Musculoskeletal: joint pain, myalgia

Skin: alopecia, radiation reactions

Other: infection, injection site reaction, hypersensitivity reactions including anaphylaxis

Interactions

Drug-drug. Carbamazepine, phenobarbital: decreased paclitaxel blood level and efficacy

Cisplatin: increased bone marrow depression (when paclitaxel dose follows cisplatin dose)

Cyclosporine, diazepam, doxorubicin, felodipine, ketoconazole, midazolam: inhibited paclitaxel metabolism and greater risk of toxicity

Doxorubicin: increased doxorubicin blood level and toxicity

Live-virus vaccines: decreased antibody response to vaccine, increased risk of adverse reactions

Other antineoplastics: increased risk of bone marrow depression

Drug-diagnostic tests. Liver function tests: abnormal results

Triglycerides: increased levels

Patient monitoring

☞ Watch closely for hypersensitivity reaction.
• Monitor heart rate and blood pressure.
• Assess infusion site for local effects and extravasation, especially during prolonged infusion.
☞ Monitor CBC, including platelet count. If neutropenia develops, monitor patient for infection; if thrombocytopenia develops, watch for signs and symptoms of bleeding.
• If patient has preexisting cardiac conduction abnormality, maintain continuous cardiac monitoring.

Patient teaching

• Instruct neutropenic patient to minimize infection risk by avoiding crowds, plants, and fresh fruits and vegetables.
• Tell thrombocytopenic patient to avoid activities that can cause injury. Advise him to use soft toothbrush and electric razor.
☞ Advise patient to promptly report signs and symptoms of infection, bleeding, or peripheral neuropathy (such as numbness and tingling of feet and hands).
• Tell patient to promptly report pain or burning at injection site.
• Explain that temporary hair loss may occur.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

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Taxol^®

Paclitaxel Oncology A chemotherapeutic used to manage Pts with ovarian, breast CAs, non-small cell lung CA, melanoma, KS who are not candidates for potentially curative surgery and/or RT Mechanism Taxol blocks mitosis by stabilizing microtubules and promoting tubulin polymerization, resulting in non-functional microtubules. See Ovarian cancer.

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Patient discussion about Taxol.

Q. How you guys have coped with the side effect of taxol. I was given Taxol after a long and heavy round of chemotherapy and was told that it will be an easy and safe drug when compared to the drugs that I have taken before …but I had severe allergic reactions for some months I think it may be a year with one being very serious that required antihistamines, with having oxygen and caused such pain in my back that I understood the highest level of discomfort. I don’t know how you guys have coped with the side effect of taxol ….I have experienced the worst possible pain in my life which cannot even come with the surgery…..but one thing I found that I was cured at least for god`s sake..

A. chemotherapy sux...i myself didn't have to go through that, but had to see someone very dear to me go through that. she went through very difficult time but survived and thank god it has been at least 2 years since and she is fine. it was frustrating to sit there not being able to do anything about it. but you should know-
it's temporary, and god's will - you'll come out of it triumphant!

Q. After Taxol/Carbo, then Alimta, treatments stopped because tumors no longer shrinking. Anything else to try? I was diagnosed with Stage 3 lung cancer about 6 months ago. Because of the weakness of my lungs due to advanced COPD, the Oncologist ruled out surgery & radiation so Chemo was the only alternative. I am now under Hospice care.

A. this is a question that the oncologist should answer...there are a lot of chemo treatments out there- but not always firring to the type of lung caner. but i'm sure he would suggest them...
look- there's some treatments in clinical trials. check them out maybe there'll be something for you. look under the topic "research":
http://www.nlm.nih.gov/medlineplus/lungcancer.html#cat27