What is Paclitaxel?
Paclitaxel is a drug used in the treatment of cancer. It belongs to a class of drugs known as taxanes, which act by preventing the growth of cancer cells. It is administered intravenously and can be used in different types of cancer, such as breast, ovarian, lung, etc.
Types of cancer in which it is used
- Breast cancer: it is one of the most common cancers in women. Paclitaxel is used especially in cases of metastatic or recurrent breast cancer.
- Ovarian cancer: this type of cancer affects the ovaries and is most common in women over the age of 50. Paclitaxel is often used in combination with other drugs to treat advanced ovarian cancer.
- Pancreatic cancer: this is one of the most aggressive tumors of the gastrointestinal tract. Albumin-bound paclitaxel, known as nab-paclitaxel, is used in combination with gemcitabine to treat metastatic pancreatic cancer. This combination has been shown to be more effective than gemcitabine alone in several clinical trials.
- Stomach cancer: paclitaxel is often used in combination with other chemotherapy drugs such as cisplatin, carboplatin and capecitabine. These combinations may be more effective than single drug treatments.
- Non-small cell lung cancer is the most common type of lung cancer, accounting for about 85% of cases. Paclitaxel is used in the treatment of this cancer, especially in advanced stages.
- Kaposi’s sarcoma is a type of cancer that affects connective tissue and is more common in people with weakened immune systems, such as patients with HIV/AIDS. Paclitaxel is used to treat advanced forms of this sarcoma.
- Cervical cancer affects the cervix and is most common in middle-aged women. Paclitaxel may be part of the treatment for advanced or recurrent cases.
- Endometrial cancer: this cancer affects the lining of the uterus and is most common in postmenopausal women. Paclitaxel is used in combination with other drugs to treat advanced cases.
- Bladder cancer affects the urinary bladder and is more common in older men. Paclitaxel can be used in advanced or metastatic cases.
- Head and neck cancer: includes several types of cancer that affect the mouth, throat and other areas of the head and neck. Paclitaxel is used in combination with other treatments for advanced cases.
- Leukemia: is a cancer of the blood and bone marrow. Although less common, paclitaxel may be part of the treatment for certain types of leukemia.
- Other indications: some tumors that do not respond to conventional first- and second-line lines can be treated with schemes that include paclitaxel.
Paclitaxel administration: How is it used in chemotherapy?
Generally, paclitaxel is administered intravenously in the Day Hospital, although it can also be used intraperitoneally in HIPEC (hyperthermic intraperitoneal chemotherapy), PIPAC (pressurized intraperitoneal aerosol chemotherapy) and NIPEC (normothermic intraperitoneal chemotherapy through a subcutaneous reservoir) procedures. Depending on the treatment schedule or the patient’s general condition, it may be appropriate for the patient to be admitted to the hospital for a few days to receive the treatment.
Requirements prior to administration
Before starting the treatment, a blood test is required (the same day or one or two days before). If the results of the blood test are normal, the hospital Pharmacy Service will prepare the medication individually, adjusting the doses to the patient’s weight and size.
Route of administration
- Intravenous: the nurse places a thin tube (cannula) into one of the veins in the hand or arm. Some people receive their treatment through a thin plastic tube inserted under the skin into a vein near the collarbone (central line) or through a vein in their arm.
- Intra-abdominal:
- HIPEC: At the end of cytoreduction surgery, a warm chemotherapy bath is performed to eliminate microscopic disease.
- PIPAC: chemotherapy is converted into an aerosol to improve distribution and penetration into the tumor nodules.
- NIPEC: through a subcutaneous reservoir in the abdomen, the patient receives multiple cycles of liquid intra-abdominal chemotherapy at room temperature.
Order of administration
Before starting the administration of chemotherapy, the patient will receive antiemetics to prevent nausea and vomiting through the cannula, which is usually connected to a drip (infusion) to introduce the drug into the vein. Antiemetic drugs are sometimes taken by mouth as tablets or capsules.
Duration of treatment
Some drugs are administered continuously while others require a rest period to allow the body to recover from adverse effects. The days of drug administration and the days of rest in between are called the “treatment cycle”.
- Ovarian cancer:
- A dose of paclitaxel is given followed by another drug called cisplatin, every 3 weeks.
- In relapses, paclitaxel is given every 3 weeks.
- Some patients may receive intraperitoneal paclitaxel in the form of HIPEC or PIPAC.
- Pancreatic cancer:
- Paclitaxel may be given in combination with gemcitabine.
- In advanced cases of cancer with peritoneal metastases, the addition of intraperitoneal chemotherapy (PIPAC or NIPEC) may be considered.
- Stomach cancer:
- Paclitaxel may be administered in combination with other drugs.
- In advanced cases of cancer with peritoneal metastases, the addition of intraperitoneal chemotherapy (PIPAC or NIPEC) may be considered.
- Breast cancer:
- After surgery: paclitaxel is administered every 3 weeks for 4 cycles.
- First time: it can be combined with other drugs such as doxorubicin or trastuzumab, every 3 weeks.
- At relapse, paclitaxel is given every 3 weeks.
- Lung cancer:
- Paclitaxel is given followed by cisplatin, every 3 weeks.
- Kaposi’s sarcoma:
- Paclitaxel is administered every 2 weeks.
Side effects
The administration of paclitaxel may result in several side effects. However, each person’s reaction to treatment is unique. There are patients who experience few adverse effects, while there are others who have more. Here are some of the most common:
- Risk of infections: paclitaxel can lead to a decrease in the number of white blood cells, making the patient more prone to infections. This effect may begin a few days after receiving treatment and usually reaches its lowest point in the days or weeks after treatment. The blood count will usually return to normal before the next cycle. If the number of blood cells becomes very low, it would be a serious adverse effect. The patient should go to the hospital directly if:
- His temperature rises above 38°C.
- He/she has bleeding or bruises for no apparent reason.
- Suddenly feels unwell (even with a normal temperature).
- Anemia: paclitaxel can lower the number of red blood cells in your blood. The decrease in red blood cells may cause fatigue, weakness and shortness of breath. In severe cases, a blood transfusion may be necessary.
- Nausea: this may occur in the first few days after chemotherapy. Nowadays there are very effective antiemetic drugs for its prevention and reduction.
- Hair loss: this may begin a few days or weeks after the first course of treatment. You may also notice hair thinning and loss of eyelashes, eyebrows and hair on other parts of the body. This is temporary and the hair will begin to grow back once treatment ends.
- Peripheral neuropathy: may cause numbness or tingling in the hands and feet, which may worsen with additional doses of the drug. In some cases, these symptoms may persist even after treatment ends.
- Muscle and joint pain: some people may experience pain in muscles and joints, as well as headaches. Your doctor may recommend medications and other strategies to relieve pain.
- Skin changes– Chemotherapy may affect the skin. Paclitaxel may cause a rash, which can be itchy.
- Nail changes: if it occurs, it is mild. The color of the nail may change, becoming darker or discolored. They may also become brittle and break easily. A few months after the end of the treatment, the nails recover their normal growth.
- Diarrhea: Although uncomfortable, mild diarrhea does not usually cause serious problems. However, severe diarrhea should be reported to the physician.
- Heart problems– Rarely, paclitaxel may cause heart problems, such as low or high blood pressure and slow heart rate. Your medical team will monitor your blood pressure and heart rate during the infusion.
- Liver toxicity: it can affect the liver, so regular liver function tests are recommended during treatment.
- Reproductive problems: paclitaxel may affect fertility, so it is important to discuss fertility preservation options with your doctor before starting treatment.
Management and reduction of side effects
Medications and complementary therapies
- Antiemetics: to control nausea and vomiting.
- Analgesics: for muscle and joint pain.
- Peripheral neuropathy: vitamin B6 and medications such as gabapentin may help relieve numbness and tingling in the hands and feet.
- Supplements: in some cases, iron supplements or blood transfusions may be necessary to treat anemia.
Personal care
- Hygiene— it is important to maintain good personal hygiene to prevent infection. Wash hands frequently and avoid contact with sick people.
- Mouth care— use a soft-bristled toothbrush and mouthwash to prevent mouth sores.
- Sun protection: wear sunscreen and protective clothing to prevent skin damage.
Psychological Support
- Considering psychological therapy or support groups can help manage treatment-related stress and anxiety.
- Practices such as meditation can help reduce stress and improve emotional well-being.
Diet and lifestyle during treatment
- Nutrient-rich foods: eat a balanced diet rich in fruits, vegetables, lean proteins and whole grains to maintain your energy and strength.
- Hydration: drink at least 2 liters of water a day to keep you hydrated, especially in cases of diarrhea.
- Eating small amounts of soft, easy-to-digest foods several times a day can help manage nausea.
- Activities such as walking or yoga can help reduce fatigue and improve mood.
Effectiveness of Paclitaxel in Cancer Treatment
Paclitaxel has been extensively studied in various types of cancer. The drug’s data sheet highlights a summary of some key findings:
- Breast Cancer: Studies have shown paclitaxel to be effective in the treatment of breast cancer, especially when used in combination with other drugs. In clinical trials, it has shown a significant response rate in patients with metastatic breast cancer.
- Ovarian cancer: a meta-analysis has indicated that weekly dosing of paclitaxel, in combination with carboplatin, may prolong progression-free survival compared to three-weekly dosing.
- Pancreatic cancer: the MPACT study established the combination of nab-paclitaxel and gemcitabine as a first-line treatment option for patients with metastatic pancreatic cancer.
- Stomach cancer: the use of paclitaxel in combination with other drugs can help reduce tumor size, relieve symptoms and prolong patients’ lives.
- Non-small cell lung cancer: one study found that paclitaxel offers a significant therapeutic advantage compared to other chemotherapy treatments, although it did not show a significant improvement in one-year survival.
Frequently Asked Questions about Paclitaxel
How long does the full course of paclitaxel treatment last?
The duration of paclitaxel treatment varies depending on the type of cancer and the specific protocol. Generally, treatment cycles are repeated every 2 to 3 weeks. For example, in breast cancer, treatment may last 3 to 6 months, while in lung cancer, it may be extended to 6-8 cycles of 3 weeks each.
Is the administration of paclitaxel painful?
Paclitaxel is administered through an intravenous infusion, which means it is inserted into a vein through a tube. Most patients do not experience pain during the infusion, although some may experience discomfort at the injection site. It is common for medications to be given to prevent allergic reactions before the infusion.
What to do in case of severe side effects?
It is crucial to contact your doctor immediately if you experience severe side effects. Some symptoms that require urgent attention include:
- High fever or chills (possible signs of infection).
- Unusual bleeding or bruising.
- Chest pain or difficulty breathing.
- Severe allergic reactions, such as swelling of the face or difficulty swallowing.
Is it possible to prevent hair loss?
Hair loss is a common side effect of paclitaxel. However, there are methods that can help reduce this effect, such as wearing cool caps during the infusion. These caps cool the scalp, which may decrease the amount of medication reaching the hair follicles and therefore reduce hair loss.
If you have any questions about advanced cancer treatments or would like detailed and personalized information, we invite you to consult with IVOQA. Our team of experts is available to guide you and answer all your concerns, providing support at every step of your treatment.
