Treatment Name: Carboplatin + Paclitaxel (Carbo/Taxol®)
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.
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.
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%)
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.
- 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®)
- A 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:
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.
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®)