Trade Names: Taxol^®, Onxal^TM

Drug Type:

Paclitaxel is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. Paclitaxel is classified as a "plant alkaloid," a "taxane" and an "antimicrotubule agent." (For more detail, see "How Paclitaxel Works" section below).

What Paclitaxel Is Used For:

• Treatment of breast, ovarian, lung, bladder, prostate, melanoma, esophageal, as well as other types of solid tumor cancers. It has also been used in Kaposi's sarcoma.

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Paclitaxel Is Given:

• Paclitaxel is given as an injection or infusion into the vein (intravenous, IV).
• Paclitaxel is an irritant. An irritant is a chemical that can cause inflammation of the vein through which it is given. If the medication escapes from the vein it can cause tissue damage. The nurse or doctor who gives Paclitaxel must be carefully trained. If you experience pain or notice redness or swelling at the IV site while you are receiving Paclitaxel, alert your health care professional immediately.
• Because severe allergic reactions have occurred in some people taking Paclitaxel, you will be asked to take medications to help prevent a reaction. Your doctor will prescribe the exact regimen.
• Paclitaxel is given over various amounts of times and in various schedules.
• There is no pill form of Paclitaxel.
• The amount of Paclitaxel and the schedule that it is given will receive depend on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose and schedule.

Side Effects:

Important things to remember about the side effects of Paclitaxel include:

• Most people do not experience all of the side effects listed.
• Side effects are often predictable in terms of their onset and duration.
• Side effects are almost always reversible and will go away after treatment is complete.
• There are many options to help minimize or prevent side effects.
• There is no relationship between the presence or severity of side effects and the effectiveness of the medication.
• The side effects of Paclitaxel and their severity vary depending on how much of the drug is given, and/or the schedule in which it is given.

The following side effects are common (occurring in greater than 30%) for patients taking Paclitaxel:

• Low blood counts. Your white and red blood cells and platelets may temporarily decrease. This can put you at increased risk for infection, anemia and/or bleeding.
• Hair loss
• Arthralgias and myalgias, pain in the joints and muscles. (see pain) Usually temporary occurring 2 to 3 days after Paclitaxel, and resolve within a few days.
• Peripheral neuropathy (numbness and tingling of the hands and feet)
• Nausea and vomiting (usually mild)
• Diarrhea
• Mouth sores
• Hypersensitivity reaction. Fever, facial flushing, chills, shortness of breath, or hives after Paclitaxel is given (see allergic reaction). The majority of these reactions occur within the first 10 minutes of an infusion. Notify your healthcare provider immediately (premedication regimen has significantly decreased the incidence of this reaction).

The following are less common side effects (occurring in 10-29%) for patients receiving Paclitaxel:

• Swelling of the feet or ankles (edema).
• Increases in blood tests measuring liver function. These return to normal once treatment is discontinued (see liver problems).
• Low blood pressure (occurring during the first 3 hours of infusion).
• Darkening of the skin where previous radiation treatment has been given (radiation recall - see skin reactions).
• Nail changes (discoloration of nail beds - rare) (see skin reactions).

Nadir: 15-21 days

This list includes common and less common side effects for individuals taking Paclitaxel. Side effects that are very rare, occurring in less than 10% of patients, are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

• Fever of 100.4° F (38° C), chills (possible signs of infection)
• Shortness of breath, wheezing, difficulty breathing, closing up of the throat, swelling of facial features, hives (possible allergic reaction).

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

• If you notice any redness or pain at the site of injection
• Nausea (interferes with ability to eat and unrelieved with prescribed medication)
• Vomiting (vomiting more than 4-5 times in a 24 hour period)
• Diarrhea (4-6 episodes in a 24-hour period)
• Unusual bleeding or bruising
• Black or tarry stools, or blood in your stools or urine
• Extreme fatigue (unable to carry on self-care activities)
• Mouth sores (painful redness, swelling or ulcers)
• Yellowing of the skin or eyes
• Swelling of the feet or ankles. Sudden weight gain
• Signs of infection such as redness or swelling, pain on swallowing, coughing up mucous, or painful urination.

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

• Before starting Paclitaxel treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, or products containing aspirin unless your doctor specifically permits this.
• Do not receive any kind of immunization or vaccination without your doctor's approval while taking Paclitaxel.
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (Paclitaxel may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
• For both men and women: Do not conceive a child (get pregnant) while taking Paclitaxel. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
• Do not breast feed while taking Paclitaxel.

Self-Care Tips:

• Paclitaxel, or the medications that you take with Paclitaxel may cause you to feel dizzy or drowsy. Do not operate any heavy machinery until you know how you respond to Paclitaxel.
• If you notice any redness or pain at the injection site, place a warm compress, and notify your healthcare provider.
• Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• You may be at risk of infection so try to avoid crowds or people with colds and those not feeling well, and report fever or any other signs of infection immediately to your health care provider.
• Wash your hands often.
• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
• Use an electric razor and a soft toothbrush to minimize bleeding.
• Avoid contact sports or activities that could cause injury.
• Paclitaxel causes little nausea. But if you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals. Sucking on lozenges and chewing gum may also help.
• Acetaminophen or ibuprofen may help relieve discomfort from fever, headache and/or generalized aches and pains. However, be sure to talk with your doctor before taking it.
• You may experience drowsiness or dizziness; avoid driving or engaging in tasks that require alertness until your response to the drug is known.
• Paclitaxel will make you sensitive to sunlight. You must wear sunglasses when outside, and avoid sun exposure. Wear protective clothing, and also wear SPF 15 (or higher) sun block.
• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
• Get plenty of rest.
• Maintain good nutrition.
• If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

You will be checked regularly by your health care professional while you are taking Paclitaxel, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.

How Paclitaxel Works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur. The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body.

Paclitaxel belongs to a class of chemotherapy drugs called plant alkaloids. Plant alkaloids are made from plants. The vinca alkaloids are made from the periwinkle plant (catharanthus rosea). The taxanes are made from the bark of the Pacific Yew tree (taxus). The vinca alkaloids and taxanes are also known as antimicrotubule agents. The podophyllotoxins are derived from the May Apple plant. Camptothecan analogs are derived from the Asian "Happy Tree" (Camptotheca acuminata). Podophyllotoxins and camptothecan analogs are also known as topoisomerase inhibitors. The plant alkaloids are cell-cycle specific. This means they attack the cells during various phases of division.

• Vinca alkaloids: Vincristine, Vinblastine and Vinorelbine.
• Taxanes: Paclitaxel and Docetaxel.
• Podophyllotoxins: Etoposide and Tenisopide.
• Camptothecan analogs: Irinotecan and Topotecan.

Antimicrotubule agents (such as Paclitaxel), inhibit the microtubule structures within the cell. Microtubules are part of the cell's apparatus for dividing and replicating itself. Inhibition of these structures ultimately results in cell death.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

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