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Treatment Name: Abraxane® (Paclitaxel protein-bound particles)

Abraxane® (Paclitaxel protein-bound particles) is a Chemotherapy Regimen for Breast Cancer - metastatic

How does Abraxane® (paclitaxel protein-bound nanoparticles) work?
Abraxane® is designed to kill or slow growth of breast cancer cells.

Other names for Abraxane®:
        • albumin-bound paclitaxel
        • nab-paclitaxel

Goals of Abraxane® (paclitaxel protein-bound nanoparticles) therapy:
Abraxane® is given to shrink tumors and alleviate symptoms of breast cancer. It is not usually given with the goal of cure.

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Schedule

  • Abraxane® intravenous (I.V.) infusion over 30 minutes on Day 1
       OR
  • Abraxane® I.V infusion over 30 minutes on Days 1, 8, and 15

Estimated total infusion time for this treatment:

  • Up to 2 hours for each treatment
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time

Abraxane® is usually given in an outpatient infusion center, allowing the person to go home afterwards. If given on Day 1 only, it is usually repeated every 21 days and called a "single-dose cycle." If given on Days 1, 8, and 15 it is called a "three-dose cycle" and repeated every 28 days.

Each cycle may be repeated until the drug stops working or until unacceptable side effects occur. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.

Click here for the common Abraxane® (paclitaxel protein-bound particles) starting dose.

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Side Effects

In clinical studies, the most commonly reported Abraxane® (paclitaxel protein-bound particles) side effects are shown here. Side effects sometimes have percentage ranges [example: 23 - 82% get neutropenia] because they differed between clinical studies:

NOTE: Hair loss from Abraxane® is almost always mild, not as obvious from a distance, and seen only on close inspection; although a different hair style can help cover some hair loss, a wig or hair piece is usually not required.

In the Gradishar Taxol comparison study, high blood sugar (19%) and flushing (16%) were seen in the Taxol (paclitaxel) group, but not in the Abraxane® group (0% for each).

In clinical studies, 7% of patients receiving a dose of 100 mg/m2 discontinued treatment due to unacceptable side effects. 

In clinical studies, 17% of patients receiving a dose of 150 mg/m2 discontinued treatment due to unacceptable side effects.

Side effect videos Side Effect Videos
Neutropenic FeverNeutropenic FeverHair LossHair LossPainPainFatigue Fatigue AnemiaAnemiaNausea and VomitingNausea and VomitingDiarrheaDiarrheaBleedingBleeding

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Monitoring

How often is monitoring needed with Abraxane® (paclitaxel protein-bound particles)?
Labs (blood tests) may be checked before each treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others the doctor may order.

How often is imaging needed?

Imaging may be checked before treatment and peridoically therafter (example: Weeks 5, 9 and 15) to assess response to Abraxane®. Imaging may include: bone scans, magnetic resonance imaging (MRI), and computerized tomography (CT) scans. A chest x-ray may be needed if there are signs or symptoms of a lung infection such as pneumonia.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue Abraxane® as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.

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ChemoExperts Tips

  • Abraxane® comes from the manufacturer as a powder for reconstitution and can take 20 to 30 minutes to fully dissolve (reconstitute) into a liquid and load into the I.V. bag. Plan on extra wait time to allow for medication preparation, especially if the infusion center is busy
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for metastatic breast cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Abraxane® (Paclitaxel protein-bound particles), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Abraxane® (Paclitaxel protein-bound particles). Depending upon your income, they may be able to help cover the cost of:

  • Pacli­taxel protein-bound

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Abraxane® (Paclitaxel protein-bound particles) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Abraxane® (Paclitaxel protein-bound particles)

Individual Drug Label Information

Pacli­taxel protein-bound (Abraxane®)

  • Abraxane is an intravenous infusion
  • Extreme caution is advised when this is given to patients with low white blood cells, known as neutrophils, are below a certain level.  Blood counts are usually checked before each infusion
  • Dosage adjustments may be required for liver dysfunction, low white blood cells, low platelets, nerve damage, or poor liver function
  • May interact with certain antifungal and seizure medications. Ask your doctor or pharmacist to review your medications for any possible interactions
  • May interact with grapefruit and grapefruit juice. This could increase your risk of experiencing side effects. Avoid eating grapefruit and drinking anything containing grapefruit juice during treatment
  • Although rare, can cause serious lung injury or shortness of breath
  • Known to cause fetal harm; this drug should be avoided during pregnancy
General Abraxane (paclitaxel protein bound particles) Side Effects
  • Low white blood cells
  • Infections due to low white blood cells may occur
  • Fever
  • Low blood platelets
  • Bleeding
  • Allergic reactions can occur
  • Pins and needles or a tingling feeling in the fingers and toes. This is reversible if caught early; notify doctor if this happens
  • Liver damage
  • Lung injury
  • Hair loss (minimal)
  • Fatigue
  • Nause and vomiting (minimized with pre-medication)
  • Diarrhea
  • Anemia
  • Click on the Abraxane® (paclitaxel protein-bound particles) package insert below for all reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossFatigue Fatigue BleedingBleedingPainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

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References

1) Gradishar WJ, Tjulandin S, Davidson N, et al. Phase III trial of nanoparticle albumin-bound paclitaxel compared with polyethylated castor oil-based paclitaxel in women with breast cancer. J Clin Oncol. 2005;23:7794-7803.

2) Gradishar WJ, Krasnojon D, Cheporov S, et al. Significantly longer progression-free survival with nab-paclitaxel compared with docetaxel as first-line therapy for metastatic breast cancer. J Clin Oncol. 2009;27:3611-3619.

Created: August 27, 2016 Updated: October 5, 2018

What is Breast Cancer - metastatic?

What is Metastatic Breast Cancer?
A disease of the milk-producing glands known as lobules, milk ducts, or other cells found in the breast. Metastatic breast cancer is one that has moved from the breast to other areas of the body, which may include the brain, liver, or bone. Breast cancer is one of the most common types of cancers in women, but may rarely affect men as well. Known causes of breast cancer include genetic causes, such as the BRCA mutation, or obesity. The effectiveness of the treatment may depend upon the stage at diagnosis.

Types of metastatic breast cancer:
1. Hormone-receptor positive or negative (60 - 65% of patients)

  • Estrogen Receptor positive (ER)+ or negative (ER)-
  • Progestin Receptor positive (PR)+ or negative (PR)-

2. Hormone Epidermal growth factor Receptor-2 (HER-2) positive or negative (20 - 25% of patients)

  • HER-2 +
  • HER-2 -

3. Triple Negative (15 - 18% of patients)

  • ER- and PR- and (HER-2)-
NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What does "Cure" mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, doctors use the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

Abraxane® (paclitaxel protein-bound particles) starting dose

  • Abraxane 260 mg/m2 intravenous (I.V.) infusion over 30 minutes on Day 1
      OR
  • Abraxane 100 mg/m2 or 150 mg/m2 I.V infusion over 30 minutes on Days 1, 8, and 15

NOTE: Doses given weekly on Days 1, 8, and 15 (three-dose cycle) are SMALLER than the dose given on Day 1 only (single-dose cycle).

Clinical Studies

If you are interested in reading the clinical trials results, please click on references below:

1) Gradishar WJ, Tjulandin S, Davidson N, et al. Phase III trial of nanoparticle albumin-bound paclitaxel compared with polyethylated castor oil-based paclitaxel in women with breast cancer. J Clin Oncol. 2005;23:7794-7803.

2) Gradishar WJ, Krasnojon D, Cheporov S, et al. Significantly longer progression-free survival with nab-paclitaxel compared with docetaxel as first-line therapy for metastatic breast cancer. J Clin Oncol. 2009;27:3611-3619.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium