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Treatment Name: Carboplatin + Paclitaxel (Carbo/Taxol®)

Carboplatin + Paclitaxel (Carbo/Taxol®) is a Chemotherapy Regimen for Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)

How does carboplatin + paclitaxel (carbo/taxol) work?
Both carboplatin and paclitaxel are chemotherapy agents that are designed to kill and slow the growth of lung cancer cells.

Goals of therapy:
Carboplatin + paclitaxel (carbo taxol) is given to shrink tumors and improve symptoms of lung cancer. If the disease is not metastatic (spread to areas of the body outside the lungs), carboplatin + paclitaxel may be given as first line adjuvant or neoadjuvant therapy with the goal of cure. If the disease is metastatic, carboplatin plus paclitaxel may not be curative, but may still prolong life and relieve certain symptoms.

Durvalumab (Imfinzi) may be given to certain patients with stage 3 unresectable non-small cell lung cancer after they complete chemotherapy plus radiation. Durvalumab is given with the goal of preventing the cancer from growing or spreading and the goal of increasing lifespan.

Schedule

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Carboplatin plus Paclitaxel (Carbo Taxol® schedule):

  • Carboplatin intravenous (I.V.) infusion over 60 minutes on Day 1
  • Paclitaxel I.V. infusion over 3 hours on Day 1

Estimated total infusion time for this treatment:

  • Up to 5 hours for Day 1 of each cycle
  • 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

Carboplatin + Taxol® is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, it may be given in the hospital if someone is too sick.

Carboplatin + Taxol® is repeated every 21 days. This is known as one Cycle. If used as adjuvant or neoadjuvant therapy, carboplatin + Taxol® typically is given for 4 cycles. If given for metastatic disease, treatment is continued until disease progression or until unacceptable side effects occur. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.

Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects of carboplatin + paclitaxel (carbo plus taxol®) are shown here:

  • Low white blood cells (84%)
  • Low red blood cells [Anemia] (57%)
  • Hair loss (45%)
  • Constipation (38%)
  • Decreased appetite (33%)
  • Fatigue (29%)
  • Nausea (25%)
  • Vomiting (22%)
  • Joint pain (22%)
  • Low platelets [thrombocytopenia] (20%)
  • Neutropenic fever (18%)
  • Muscle pain (18%)
  • Weakness and tingling in fingers and toes (17%)
  • Diarrhea (7%)
  • Fever (6%)
  • Swelling or pain at infusion site (5%)
  • Inflammation of the lungs (1%)

Side effect videos Side Effect Videos
AnemiaAnemiaHair LossHair LossConstipationConstipationFatigue Fatigue Nausea and VomitingNausea and VomitingPainPainNeutropenic FeverNeutropenic FeverDiarrheaDiarrhea

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before each treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment, during treatment if there are concerns for disease progression or side effects, or at the end of treatment to determine response to treatment. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans.

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

ChemoExperts Tips

  • Paclitaxel can cause infusion reactions due to cremophor that is used in the IV formulation. Patients may receive several medications prior to receiving paclitaxel (this is known as "pre-medication") to decrease the risk of infusion reactions. Common pre-medications given are a histamine-2 blockers such as famotidine (Pepcid®) or ranitidine (Zantac®), a histamine-1 blocker such as diphenhydramine (Benadryl®), and a corticosteroid such as dexamethasone (Decadron®)
  • Carboplatin hypersensitivity reaction can be severe. This reaction is most common around the 8th or 9th cycle, but can happen after any dose. Some institutions may use "desensitization protocols" to allow a person to keep receiving carboplatin after they have had a reaction. Desensitization is used if someone is receiving a good response from carboplatin, or if few other chemotherapy or immunotherapy options are available to treat the lung cancer
  • Patients and their caregivers should be counseled to recognize the signs and symptoms of drug reactions and reports them immediately, even after they have left the clinic
  • If you have locally advanced, stage 3 unresectable (cancer that cannot be removed with surgery) non-small cell lung cancer and also complete at least 2 cycles of platinum-containing chemotherapy (medications such as cisplatin or carboplatin) given at the same time as radiation, you may qualify for a medication known as durvalumab (Imfinzi) when chemoradiotherapy is complete. Roughly 25% of patients with non-small cell lung cancer have stage 3 disease at diagnosis and a proportion of these will have unresectable disease.
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for NSCLC. 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 Carboplatin + Paclitaxel (Carbo/Taxol®), 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 Carboplatin + Paclitaxel (Carbo/Taxol®). Depending upon your income, they may be able to help cover the cost of:

  • Carboplatin
  • Paclitaxel

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 Carboplatin + Paclitaxel (Carbo/Taxol®) 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 Carboplatin + Paclitaxel (Carbo/Taxol®)

Individual Drug Label Information

Carboplatin (Paraplatin®)

  • Carboplatin is an intravenous infusion 
  • This medication is dosed based on your kidney function. If your kidney function improves or worsens during therapy, your dose may need to be adjusted
  • This drug should not be used during pregnancy, it may cause fetal harm
General Carboplatin (Paraplatin) Side Effects:  
  • Low red blood cells, low white blood cells, and most commonly, low platelets can be occur
  • Nausea and vomiting is common but can be prevented by taking certain pre-medications
  • Hair loss
  • Constipation and/or diarrhea
  • Pain
  • Allergic reactions to carboplatin can occur. These typically are not seen until after the 6th dose of carboplatin is given 
  • Can cause liver damage at high doses 
  • May cause kidney damage or hearing loss if combined with other medications that also cause these side effects 
  • Click on the carboplatin (Paraplatin) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossBleedingBleedingConstipationConstipationPainPainAnemiaAnemia

See DailyMed package insert.

Paclitaxel (Taxol®)

  • Paclitaxel is an intravenous infusion
  • There is a risk for serious infusion reactions such as trouble breathing, low blood pressure, severe swelling, or hives. These reactions are due to a component in the solution called Cremophor. You will receive several medications before receiving paclitaxel to decrease the risk of experiencing an infusion related reaction that include: a corticosteroid, diphenhydramine (Benadryl), and histamine-2 antagonists (Zantac or Pepcid).Patients who experience these type of severe reactions should not be rechallenged with paclitaxel.
  • This drug can cause low white blood cell counts. Complete blood counts (CBC) will be checked before each treatment to make sure your white blood cells are at a safe enough to use this drug
  • Dosage adjustments may be required for liver dysfunction, nerve pain or toxicity, low white blood cells, or low blood platelets
  • Nerve pain usually starts as tingling or a "pins and needles" feeling in the fingers or toes, but can worsen over time and lead to numbness. It is important to notify the doctor if there are any signs of nerve damage. If caught early, this is typically reversible but can become permanent if not addressed
  • Interacts with certain antifungal, blood pressure, cholesterol, erectile dysfunction, sedative, antibiotic, and anti-seizure medications.  Ask your doctor or pharmacist to review your medications for any possible interactions
  • Known interaction with grapefruit or grapefruit juice. Avoid eating grapefruit and drinking grapefruit juice as they may increase your risk of experiencing side effects
  • Avoid the natural supplement St. John’s Wort as this can possibly decrease the effectiveness of paclitaxel
  • Injection site skin reactions can occur:  itching, skin infection, skin falling off, skin death, and redness. Report any of these to your physician, even if this occurs several days after an infusion
  • Can cause fetal harm; this drug should not be used during pregnancy.  Women should avoid becoming pregnant while on this drug
General Paclitaxel (Taxol) Side Effects
  • Low blood neutrophil count (neutropenia)
  • Low white blood cells
  • Nerve pain and general pain
  • Low red blood cells and related fatigue
  • Infusion reactions - hypersensitivity
  • Hair loss
  • Nausea
  • Diarrhea
  • Mouth sores
  • Low blood pressure
  • Liver problems
  • Constipation
  • Fever and infection
  • Bleeding
  • Injection site reactions
  • Nail discoloration; usually reversible once paclitaxel is stopped
  • Click on the paclitaxel (Taxol) package insert below for all manufacturer reported side effects and possible drug interactions

Side Effect Videos
DiarrheaDiarrheaHair LossHair LossFatigue Fatigue BleedingBleedingConstipationConstipationPainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

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References

1) Ohe Y, Ohashi Y, Kubota K, et al. Randomized phase III study of cisplatin plus irinotecan versus carboplatin plus paclitaxel, cisplatin plus gemcitabine, and cisplatin plus vinorelbine for advanced non-small-cell lung cancer: Four-Arm Cooperative Study in Japan. Ann Oncol. 2007;18:317-323.

2) Strauss GM, Herndon JE 2nd, Maddaus MA, et al. Adjuvant paclitaxel plus carboplatin compared with observation in stage IB non-small-cell lung cancer: CALGB 9633 with the Cancer and Leukemia Group B, Radiation Therapy Oncology Group, and North Central Cancer Treatment Group Study Groups. J Clin Oncol. 2008;26:5043-5051.

3) Dempke WCM, Fenchel K. Durvalumab for non-resectable stage IIIB non-small cell lung cancer-a small step or a big leap? Transl Lung Cancer Res. 2018 Apr;7(Suppl  2):S153-S157.

Created: March 13, 2019 Updated: April 28, 2019

What is Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)?

What is Non-Small Cell Lung Cancer?
A disease of the tissue found in the lung.  Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Known causes include smoking and exposure to environmental toxins.  The stage of NSCLC can vary at diagnosis and throughout treatment.  Stages include stage I, II, III, and IV.  The effectiveness of the treatment may depend upon the stage at diagnosis.

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.

Common Carboplatin + Paclitaxel (Carbo/Taxol®) starting doses

  • Carboplatin AUC 6 intravenous (I.V.) infusion over 60 minutes on Day 1
  • Paclitaxel 200 mg/m2 I.V. infusion over 3 hours on Day 1

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability.

What is Adjuvant Chemotherapy?

Adjuvant chemotherapy is given after surgical removal of the primary cancer tumor. The goal of adjuvant chemotherapy is to target microscopic cancer cells that may remain after surgical removal of the primary tumor to help prevent recurrence of the disease.

What is Neoadjuvant Chemotherapy?

Neoadjuvant chemotherapy is given before surgery or radiation with the goal of shrinking the primary cancer tumor to make either surgical removal of the tumor or radiation of the tumor easier.

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, 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.

Clinical studies

1) Ohe Y, Ohashi Y, Kubota K, et al. Randomized phase III study of cisplatin plus irinotecan versus carboplatin plus paclitaxel, cisplatin plus gemcitabine, and cisplatin plus vinorelbine for advanced non-small-cell lung cancer: Four-Arm Cooperative Study in Japan. Ann Oncol. 2007;18:317-323.

2) Strauss GM, Herndon JE 2nd, Maddaus MA, et al. Adjuvant paclitaxel plus carboplatin compared with observation in stage IB non-small-cell lung cancer: CALGB 9633 with the Cancer and Leukemia Group B, Radiation Therapy Oncology Group, and North Central Cancer Treatment Group Study Groups. J Clin Oncol. 2008;26:5043-5051.

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