Treatment Name: Paclitaxel (Taxol®)
Paclitaxel (Taxol®) is a Chemotherapy Regimen for Breast Cancer - early stage
How does Paclitaxel work?
It is a chemotherapy drug designed to prevent cancer cells from dividing into more cancer cells.
Goals of therapy:
Paclitaxel is commonly given to kill any remaining cancer cells after surgery is performed. This reduces the risk of the cancer coming back in the same breast, or the other breast. Paclitaxel is commonly given with the goal of cure.
How is paclitaxel therapy for breast cancer given?
- Paclitaxel intravenous (I.V.) given over three hours on Day 1 of every 21-day cycle (four doses total)
- Paclitaxel I.V. given over one hour, once per week for 12 straight weeks
- Patients with hormone-receptor positive breast cancer cells may benefit from further treatment with oral anti-estrogen tablets such as tamoxifen, letrozole, or anastrozole to reduce the risk of the cancer coming back
Click here for common starting doses
Estimated total infusion time for this treatment:
- Up to four hours for the infusion given on the every 3-week schedule
- Up to two hours for the infusion given every week
- 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
Paclitaxel is usually given in an outpatient infusion center, allowing the person to go home afterwards. Once all treatment with paclitaxel is complete, then oral anti-estrogen medications may be taken at home.
Duration of therapy may last up to four months, depending upon response, tolerability, and number of cycles prescribed.
What are the most common side effects from paclitaxel for breast cancer?
In clinical studies, the most commonly reported paclitaxel side effects are shown here:
- Nerve pain, or neuropathy:
-Paclitaxel given weekly (27%)
-Paclitaxel given every 3 weeks (20%)
- Fatigue (3%)
- Infection (3%)
- Muscle or bone pain:
-Paclitaxel given weekly (2%)
-Paclitaxel given every 3 weeks (7%)
- Neutropenic fever (1%)
*Although hair loss was not reported in this dose-response study, it can occur in up to 50% of patients. See DailyMed package insert.
Watch videos on common paclitaxel therapy side effects below
Side effect videos
PainFatigue Neutropenic FeverHair LossAnemia
How often is monitoring needed?
Labs (blood tests) will likely be checked before every new cycle of chemotherapy 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 such as a chest x-ray, computerized tomography (CT) scan, or magnetic resonance imaging (MRI) scan may be checked before treatment, or after treatment if your doctor recommends based upon your specific situation.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue paclitaxel as planned, or delay or switch therapy. For example, if the CBC blood test shows that the neutrophil (infection-fighting white blood cells) count is below normal, your doctor may delay treatment.
What are the 3 most important things to know about paclitaxel while receiving treatment?
- Paclitaxel may cause a reaction during the infusion known as hypersensitivity. The reaction is most often prevented using several medications, such as diphenhydramine (Benadryl®), either ranitidine or famotidine, and a steroid such as dexamethasone
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for early stage 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 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 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 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 Paclitaxel (Taxol®)
Individual Drug Label Information
- 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
- 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
- Mouth sores
- Low blood pressure
- Liver problems
- Fever and infection
- 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
See DailyMed package insert.
DiarrheaHair LossFatigue BleedingConstipationPainAnemiaNeutropenic Fever
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Sparano JA, Wang M, Martino S, et al. Weekly paclitaxel in the adjuvant treatment of breast cancer. N Engl J Med. 2008;358:1663-1671.
Created: January 21, 2016 Updated: September 24, 2018
What is Breast Cancer - early stage?
What is Early Stage Breast Cancer?
A disease of either the milk-producing glands known as lobules, or milk ducts, or other cells found in the breast. Early stage breast cancer may also affect the lymph nodes, but has not usually spread to other areas of the body. Breast cancer is the most common type of cancer diagnosed in women, but may rarely affect men as well. Breast cancer cells may have increased expression of estrogen receptors (ER positive or negative), progestin receptors (PR positive or negative), and/or HER-2 receptors (HER-2 positive or negative). The presence or lack of these receptors will help determine the most effective chemotherapy medications to give.
Genetic causes, such as the BRCA (pronounced "Bracka") mutation, significantly increase the risk of developing breast cancer. Other risk factors for breast cancer include family history of breast cancer, high fat diet, and obesity. The stage of breast cancer can vary at diagnosis and throughout treatment. Stages of breast cancer include I, II, III, and IV. The effectiveness of the treatment may depend upon the stage at diagnosis.
Types of 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 + (positive)
- HER-2 - (negative)
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.
Common Starting Doses
- Paclitaxel 175 mg/m2 intravenous infusion (I.V.) given over three hours on Day 1 of every 3-week cycle (4 doses total)
- Paclitaxel 80 mg/m2 I.V. given over one hour on Day 1 of every 1-week cycle (12 doses total)
If you are interested in reading the clinical trials results, please click on references below:
Sparano JA, Wang M, Martino S, et al. Weekly paclitaxel in the adjuvant treatment of breast cancer. N Engl J Med. 2008;358(16):1663-1671.
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
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.