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

Carboplatin + Paclitaxel (Carbo/Taxol®) is a Chemotherapy Regimen for Ovarian Cancer

How does carboplatin + paclitaxel work?
Both carboplatin and paclitaxel are designed to kill and slow the growth of cancer cells.

Goals of therapy:
Carboplatin + paclitaxel (also known as carbo-taxol) is given to shrink tumors and alleviate (lessen) symptoms of ovarian cancer. If the disease is not metastatic (spread outside the abdomen), carboplatin + paclitaxel is commonly given with the goal of cure. If the disease is metastatic, carboplatin + paclitaxel may not be curative, but may still prolong life and relieve symptoms.

Schedule

  • Carboplatin intravenous infusion (I.V.) over at least 15 minutes (commonly 30 or 60 minutes) on Day 1
  • Paclitaxel (larger dose) I.V. over 3 hours on Day 1

                                  OR

  • Carboplatin intravenous infusion (I.V.) over at least 15 minutes (commonly 30 or 60 minutes) on Day 1
  • Paclitaxel (smaller dose) I.V. over 1 hour on Days 1, 8, and 15

Estimated total infusion time for this treatment:

  • Up to 5 hours on Day 1 (if paclitaxel is large dose)
  • Up to 2.5 hours on Day 1 (if paclitaxel is small dose) - Days 8 and 15 as short as 1.5 hours
  • 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

Click here for common starting doses.

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

Carboplatin + paclitaxel is repeated every 21 days. This is known as one Cycle. Three to six cycles are initially given for earlier-stage disease, and six to eight cycles are recommended for patients with advanced-stage cancer. Duration of therapy may last up to 8 months, depending 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 with carboplatin + paclitaxel are shown here. Side effects sometimes have percentage ranges [example: low red blood cells 60 – 69%] because they differed between clinical studies:

Side effect videos Side Effect Videos
AnemiaAnemiaHair LossHair LossPainPainNausea and VomitingNausea and VomitingFatigue Fatigue DiarrheaDiarrheaConstipationConstipationNeutropenic FeverNeutropenic FeverBleedingBleeding

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before each treatment and periodically during each cycle. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), complete blood count (CBC), CA-125 (a tumor marker for ovarian cancer), plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment and periodically during and after treatment. Imaging may include: computed tomography (CT) scans, magnetic resonance imaging (MRI), positron emission tomography (PET) scans, or X-rays.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue carboplatin + paclitaxel as planned, or delay or switch therapy.

ChemoExperts Tips

  • Paclitaxel tends to cause infusion reactions that can be related to the 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
  • 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 options are available
  • 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
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for ovarian 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 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. Ozols RF, Bundy BN, Greer BE, et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin andpaclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol 2003 Sep1;21(17):3194-3200.

2. Katsumata N, Yasuda M, Takahashi F,et al. Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer; a phase 3, open-label, randomised controlled trial. Lancet 2009;374:1331-1338.

3. Pignata S, Scambia G, Ferrandina G,et al. Carboplatin plus paclitaxel versus carboplatin plus pegylated liposomal doxorubicin as first-line treatment for patients with ovarian cancer: the MITO-2 randomized phase III trial. J Clin Oncol 2011;29:3628-35.

4. Sliesoraitis S, Chikhale PJ. Carboplatin hypersensitivity. Int J Gynecol Cancer. 2005;15:13-18.

Created: December 2, 2015 Updated: September 22, 2018

What is Ovarian Cancer?

What is Ovarian Cancer?
A disease of the cells found in the ovaries in women. Ovarian cancer is not common, but is the fifth leading cause of cancer related death in women. The exact cause is not known, however risk factors include: older age, obesity, first period at an early age, late menopause, hormone replacement therapy (HRT) after menopause, family history, and genetic causes such as the BRCA (pronounced "bracka") mutation. The use of oral contraceptives or having one or more full-term pregnancies can decrease the risk of ovarian cancer.

The stage of ovarian cancer can vary at diagnosis and throughout treatment. Ovarian cancer is staged using the Tumor, Node, Metastasis (TNM) staging system, as well as Stage Grouping I, II, III, or IV. Staging systems describe the extent of cancer throughout the body and help doctors determine which treatments to offer. 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 Starting Doses

Carboplatin AUC 5-6 IV over at least 15 minutes (commonly 30 or 60 minutes), Day 1 
Paclitaxel 175 mg/m2 IV over 3 hours, Day 1
                         OR
Carboplatin AUC 5-6 IV over at least 15 minutes (commonly 30 or 60 minutes), Day 1
Paclitaxel 80 mg/m2 IV over 1 hour, Days 1, 8, and 15 (dose-dense paclitaxel) 

Cycle is 21 days for both regimens

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

Clinical Studies

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

1. Ozols RF, Bundy BN, Greer BE, et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin andpaclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol 2003 Sep1;21(17):3194-3200.

2. Katsumata N, Yasuda M, Takahashi F,et al. Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer; a phase 3, open-label, randomised controlled trial. Lancet 2009;374:1331-1338.

3. Pignata S, Scambia G, Ferrandina G,et al. Carboplatin plus paclitaxel versus carboplatin plus pegylated liposomal doxorubicin as first-line treatment for patients with ovarian cancer: the MITO-2 randomized phase III trial. J Clin Oncol 2011;29:3628-35.

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

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.