paclitaxel at a glance
Medicine class
Taxane cytotoxic chemotherapy
Administration
Given into a vein by a trained cancer-care team
Formulations
Conventional solvent-based and albumin-bound formulations are not interchangeable
Important monitoring
Blood counts, liver function, nerve symptoms and infusion reactions
What is paclitaxel used for?
The licensed indication depends on the exact formulation. Selected UK products are used for:
Conventional paclitaxel: specified settings in ovarian cancer, breast cancer and advanced non-small cell lung cancer.
Conventional paclitaxel: advanced AIDS-related Kaposi’s sarcoma after failure of prior liposomal anthracycline treatment.
Albumin-bound paclitaxel: metastatic breast cancer after failure of first-line metastatic treatment when standard anthracycline-containing therapy is unsuitable.
Albumin-bound paclitaxel with gemcitabine: first-line treatment of metastatic pancreatic adenocarcinoma.
Albumin-bound paclitaxel with carboplatin: first-line treatment of non-small cell lung cancer when potentially curative surgery or radiotherapy is unsuitable.
How does paclitaxel work?
Paclitaxel binds to microtubules, structures cells use when dividing, and prevents their normal disassembly. This disrupts cell function and mitosis, making rapidly dividing cancer cells more likely to stop growing or die.
paclitaxel preparations and strengths
Dispersion for infusion
Route: Intravenous
Strengths: 5 mg/mL
Solution for infusion
Route: Intravenous
Strengths: 6 mg/mL
How to take paclitaxel
Paclitaxel is prepared and given into a vein in a specialist cancer unit; it is not taken by mouth. Conventional paclitaxel is diluted before use and generally needs medicines beforehand to reduce hypersensitivity reactions. Albumin-bound paclitaxel has different preparation, filtration and premedication requirements. Confirm the exact product because formulations must not be substituted for one another.
Keep the hospital’s 24-hour contact number available.
Tell the team before treatment about new infection symptoms, numbness or tingling, breathing problems, and all medicines or supplements.
Tell the nurse immediately if the infusion site becomes painful, swollen, red or burning.
paclitaxel side effects
Common or expected effects
- Reduced white blood cells and increased infection risk
- Anaemia or reduced platelets, causing tiredness, breathlessness, bruising or bleeding
- Numbness, tingling or pain in the hands and feet
- Hair loss
- Tiredness
- Muscle or joint pain
- Nausea, vomiting, diarrhoea or sore mouth
- Skin or nail changes
Get urgent medical advice
- Severe hypersensitivity or anaphylaxis, including breathing difficulty, swelling or marked dizziness
- Neutropenic infection or sepsis
- Unusual or persistent bleeding
- New or worsening breathlessness, cough or fever that may indicate pneumonitis
- Severe or disabling peripheral neuropathy
- Severe skin reactions with blistering or peeling
- Tissue injury from leakage outside the vein
paclitaxel in pregnancy
Paclitaxel may harm a developing baby and is generally avoided during pregnancy unless specialist assessment concludes treatment is clinically necessary. Evidence from pregnancies exposed to taxanes remains limited. Discuss contraception, pregnancy testing and fertility preservation before treatment where relevant, and contact the cancer team promptly if pregnancy occurs.
paclitaxel while breastfeeding
Breastfeeding is contraindicated during treatment because paclitaxel may expose the infant to serious toxicity. Advice after treatment differs between formulations; obtain product-specific guidance before restarting breastfeeding.
paclitaxel interactions
The oncology team should review prescribed, non-prescription and herbal products before treatment. Important examples include:
Strong or clinically relevant CYP2C8/CYP3A4 inhibitors
Azole antifungals, some macrolide antibiotics, gemfibrozil, clopidogrel and certain HIV antivirals may increase exposure and toxicity.
CYP2C8/CYP3A4 inducers
Rifampicin, carbamazepine, phenytoin, efavirenz, nevirapine and St John’s wort may reduce exposure and effectiveness.
Common questions about paclitaxel
Answers are fully visible for fast scanning and source review.
Is Abraxane the same as conventional paclitaxel?
Both contain paclitaxel, but Abraxane contains albumin-bound nanoparticles. Their indications, pharmacokinetics, preparation and administration differ, so they are not interchangeable.
Why are medicines given before conventional paclitaxel?
Corticosteroid, antihistamine and acid-suppressing premedicines reduce the risk of severe hypersensitivity reactions associated with conventional solvent-based paclitaxel.
Does albumin-bound paclitaxel always need allergy premedication?
Not routinely for every patient, because it does not use the same solvent as conventional paclitaxel. Severe reactions can still occur.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.