Treatment Name: Cisplatin + Paclitaxel (Taxol®)
Cisplatin + Paclitaxel (Taxol®) is a Chemotherapy Regimen for Cervical Cancer
How does cisplatin + paclitaxel (Taxol) work?
Each of the medications in cisplatin + paclitaxel are designed to kill cancer cells or slow the growth of cervical cancer cells.
Goals of therapy:
Cisplatin and paclitaxel, also known as “cis/taxol,” is given to shrink tumors and decrease symptoms from cervical cancer. Cisplatin and paclitaxel for cervical cancer is not commonly given with the goal of cure.
- Paclitaxel intravenous (I.V.) infusion given over 3 hours on Day 1
- Cisplatin I.V. infusion given over one hour on Day 1
- Paclitaxel continuous I.V. infusion given over 24 hours on Day 1, ending on Day 2
- Cisplatin I.V. infusion given over one hour on Day 2
Estimated total infusion time for this cisplatin and paclitaxel (cis/taxol) for cervical cancer:
- If paclitaxel is given over 3 hours: Up to 5 hours for Day 1 of each cycle
- If paclitaxel is given over 24 hours: Up to 3 hours for Day 1 of each cycle is spent at the infusion center. Up to 2 hours for Day 2 of each cycle
- Typically, I.V. hydration is given both before and after cisplatin and add two or more hours to the infusion time
- 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
Cisplatin and paclitaxel are usually given in an outpatient infusion center, allowing the person to go home afterwards. If paclitaxel is given over 24 hours, it will typically be started in the infusion center but patients will continue to receive their continuous infusion via ambulatory (home) infusion pump and return to the infusion center the next day to disconnect the pump and receive their cisplatin infusion. On occasion, it may be given in the hospital if someone is too sick.
Cisplatin and paclitaxel is repeated every 21 days. This is known as one Cycle. Each cycle may be repeated until the treatment no longer works or until unacceptable side effects occur. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.
Click here for the common cisplatin and paclitaxel starting doses for cervical cancer.
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 cisplatin plus paclitaxel side effects are shown here:
- Low white blood cells [neutropenia] (82%)
- Anemia [low red blood cells] (70%)
- Nausea and vomiting* (61%)
- Muscle or joint pain (54 – 67%)
- Tingling or numbness in tips of fingers or toes (36 - 52%)
- Increased bleeding risk [low platelets; thrombocytopenia] (37%)
- Mouth sores (up to 30%)
- Hair loss (12%)
- Fever (16%)
- Kidney injury (14%)
- Skin rash or other skin changes (6%)
- Heart rhythm problem (5%)
*The actually incidence of nausea or vomiting may be lower due to the availability of newer medicines used to prevent and treat nausea and vomiting since the date of clinical trial publication.
Hair loss from paclitaxel is often noticeable. A wig or hair piece may be desired to camouflage the absence of hair until it grows back. The incidence or amount of hair loss does not differ between the 3-hour or 24-hour infusions.
Neutropenic fever, when it occurs, is more common with the 24-hour paclitaxel infusion vs. the 3-hour paclitaxel infusion
How often is monitoring needed?
Labs (blood tests) may be checked before each treatment and in-between treatments at the discretion of your doctor. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), magnesium, plus any others your doctor may order.
How often is imaging needed?
Imaging may be checked before treatment and periodically during treatment at the discretion of your doctor. Imaging may include: X-rays, magnetic resonance imaging (MRI), or computerized tomography (CT) scans. A hearing exam may be recommended prior to beginning treatment with cisplatin.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue cisplatin + paclitaxel as planned, or delay or switch therapy. A dose reduction in cisplatin or a change in therapy may be recommended for uncontrolled nausea or vomiting, nerve pain, or hearing loss. Cisplatin doses may be delayed if the kidney function, as measured using the CMP, is not adequate. A dose reduction in paclitaxel or a change in therapy may be recommended for neutropenic fever, nerve pain, or liver dysfunction
- Paclitaxel may cause an infusion-related reaction. 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®). It is important to wait at least 30 minutes after pre-medication before paclitaxel infusion begins in order for the pre-medications to work.
- Intravenous (I.V.) fluids may be given while receiving cisplatin to maintain good hydration and protect against kidney damage. These fluids may contain electrolytes such as potassium and magnesium
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for cervical 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 Cisplatin + Paclitaxel (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 Cisplatin + Paclitaxel (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 Cisplatin + Paclitaxel (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 Cisplatin + Paclitaxel (Taxol®)
What is Cervical Cancer?
A disease of the cells that line the inside of the uterine cervix. Cervical cancer is decreasing in the United States, but is still common worldwide. Known causes of cervical cancer include persistent infection with the Human Papilloma Virus (HPV), history of smoking, history of sexually transmitted diseases, certain autoimmune diseases, and chronic immunosuppression.
The stage of cervical cancer can vary at diagnosis. Stages of cervical cancer include I, II, III, IV. The effectiveness of the treatment and the goal of cure 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.
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.
Common cisplatin and paclitaxel starting doses
- Paclitaxel 175 mg/m2 intravenous (I.V.) infusion over 3 hours on Day 1
- Cisplatin 50 mg/m2 I.V. infusion over 1 hour on Day 1
- Paclitaxel 135 mg/m2 continuous I.V. infusion over 24 hours on Day 1, ending Day 2
- Cisplatin 50 mg/m2 I.V. infusion over 1 hour on Day 2
If you are interested in reading the clinical trials results, please click on reference below:
1) Moore DH, Blessing JA, McQuellon RP, et al. Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: a gynecologic oncology group study. J Clin Oncol. 2004;22:3113-3119.
2) Eisenhauer EA, ten Bokkel Huinink WW, Swenerton KD, et al. European-Canadian randomized trial of paclitaxel in relapsed ovarian cancer: high-dose versus low-dose and long versus short infusion. J Clin Oncol. 1994;12:2654-2666.
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.
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 status, 2) 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
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein
13) Serum glucose
14) Serum calcium