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Paclitaxel: Brands, Price & Uses in Bangladesh
Paclitaxel is a taxane-class chemotherapy agent used in the treatment of several solid-organ malignancies.
About Paclitaxel
Indications of Paclitaxel
Paclitaxel is a taxane-class chemotherapy agent used in the treatment of several solid-organ malignancies. Its indications are classified below by strength of evidence.
Established / FDA-approved indications
- Ovarian carcinoma: First-line therapy (in combination with cisplatin) and second-line/subsequent therapy for advanced or metastatic carcinoma of the ovary.
- Breast cancer: Adjuvant treatment of node-positive breast cancer, administered sequentially after standard anthracycline-containing combination chemotherapy; and treatment of metastatic breast cancer after failure of combination chemotherapy or relapse within 6 months of adjuvant chemotherapy.
- Non-small cell lung cancer (NSCLC): First-line treatment, in combination with cisplatin, for patients who are not candidates for potentially curative surgery and/or radiation therapy.
- AIDS-related Kaposi's sarcoma: Second-line treatment.
Combination-therapy dependent uses
Paclitaxel is used together with other agents (most commonly a platinum compound such as cisplatin or carboplatin) for ovarian cancer and NSCLC; it is not intended as monotherapy in these settings.
Other (guideline-supported / off-label) uses
Guideline-supported off-label use of Paclitaxel also occurs in some other solid tumours (e.g. certain gastric, cervical, endometrial, and head-and-neck cancers) as part of multidisciplinary oncology protocols; such use should be guided by an oncologist based on current treatment guidelines.
Dosage & Administration of Paclitaxel
Paclitaxel dosing is individualised by indication, treatment protocol, and patient tolerance, and must only be prescribed and supervised by a physician experienced in the use of cancer chemotherapeutic agents. Standard premedication and administration precautions (see Administration and Precautions and Warnings) are required before every infusion.
Typical adult dosing by indication
| Indication | Typical Paclitaxel Dose | Schedule |
|---|---|---|
| Ovarian carcinoma (first-line, with cisplatin) | 135 mg/m² over 24 hours, or 175 mg/m² over 3 hours | Every 3 weeks, for a physician-determined number of cycles (commonly 6) |
| Ovarian carcinoma (subsequent therapy) | 135–175 mg/m² over 3 hours | Every 3 weeks |
| Breast cancer (adjuvant, after anthracycline-based chemotherapy) | 175 mg/m² over 3 hours | Every 3 weeks, for 4 cycles |
| Breast cancer (metastatic) | 175 mg/m² over 3 hours | Every 3 weeks |
| Non-small cell lung cancer (with cisplatin) | 135 mg/m² over 24 hours | Every 3 weeks (Paclitaxel given before cisplatin) |
| AIDS-related Kaposi's sarcoma | 135 mg/m² over 3 hours every 3 weeks, or 100 mg/m² over 3 hours every 2 weeks | Per protocol and tolerance |
Doses are given as an intravenous infusion, diluted as described under Reconstitution, and administered through an in-line filter. Treatment is generally not repeated until the neutrophil count recovers to at least 1,500 cells/mm³ (1,000 cells/mm³ for Kaposi's sarcoma) and platelets to at least 100,000 cells/mm³.
Dose adjustments
- Hepatic impairment: dose reduction is recommended based on the severity of impairment and infusion schedule, per institutional protocol.
- Severe neutropenia or peripheral neuropathy: subsequent doses are reduced (commonly by about 20%); see Precautions and Warnings.
- Renal impairment: limited data; use with caution.
Pediatric use: safety and efficacy of Paclitaxel have not been established in children (see Use in Special Populations).
Side Effects of Paclitaxel
Adverse effects of Paclitaxel are common and dose/schedule-dependent. Serious reactions (hypersensitivity, bone marrow suppression, peripheral neuropathy) are discussed fully under Precautions and Warnings; only a brief mention is given here.
Very common (occur in most patients)
- Alopecia (hair loss) — occurs in nearly all patients.
- Myelosuppression, chiefly neutropenia (see Precautions and Warnings).
- Peripheral sensory neuropathy — numbness/tingling of hands and feet (see Precautions and Warnings).
- Myalgia and arthralgia, typically 2–3 days after infusion.
- Nausea, vomiting, diarrhoea, and mucositis (mouth sores).
- Mild hypersensitivity reactions such as flushing, rash, or mild dyspnoea (see Precautions and Warnings for severe reactions).
Common
- Elevated liver enzymes.
- Injection-site reactions (redness, swelling; extravasation can cause tissue injury).
- Fatigue and asthenia.
Uncommon/rare
- Cardiac conduction abnormalities, including asymptomatic bradycardia.
- Severe anaphylactoid hypersensitivity reactions (see Precautions and Warnings).
- Interstitial pneumonitis.
Contraindications of Paclitaxel
Paclitaxel is contraindicated in:
- Patients with a known history of severe hypersensitivity reactions to Paclitaxel or to other drugs formulated in polyoxyethylated castor oil (Cremophor EL).
- Patients with solid tumours who have a baseline neutrophil count below 1,500 cells/mm³, and patients with AIDS-related Kaposi's sarcoma who have a baseline neutrophil count below 1,000 cells/mm³.
Frequently Asked Questions about Paclitaxel
What is Paclitaxel used for?
Paclitaxel is a chemotherapy medicine used to treat certain cancers, including ovarian cancer, breast cancer, non-small cell lung cancer, and AIDS-related Kaposi's sarcoma. It is given as an intravenous infusion by a cancer specialist, usually in combination with other anticancer medicines.
Why do I need pre-medications before receiving Paclitaxel?
Before every infusion, patients receive a corticosteroid, an antihistamine, and an H2-blocker to reduce the risk of severe hypersensitivity (allergic) reactions, which can occur with Paclitaxel, especially during the first two infusions. Skipping premedication increases the risk of a serious reaction.
Will Paclitaxel cause hair loss?
Yes, alopecia (hair loss), including body hair, occurs in nearly all patients receiving Paclitaxel. Hair typically begins to regrow after treatment ends.
What is peripheral neuropathy and why does Paclitaxel cause it?
Paclitaxel commonly causes numbness, tingling, or burning in the hands and feet, called peripheral neuropathy, because it affects nerve function as well as cancer cells. This is dose-related and usually improves after treatment, though it can persist in some patients; report new or worsening symptoms to your doctor.
Can Paclitaxel be used during pregnancy or breastfeeding?
No. Paclitaxel is a cytotoxic drug that can harm a developing fetus and is contraindicated in pregnancy; breastfeeding should also be stopped during treatment with Paclitaxel. Effective contraception is recommended during and after treatment — discuss this with your oncologist.
What should I do if I think I received too much Paclitaxel or experience a severe reaction?
Because Paclitaxel is given in a hospital or clinic setting under close monitoring, overdose is uncommon, but if you notice symptoms of a severe reaction (difficulty breathing, swelling, severe rash, fainting) during or after an infusion, tell the medical staff immediately or seek emergency medical attention right away.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.