| Cycle length: 28 days. |
| Drug | Dose and route | Administration | Given on days |
| Paclitaxel | 80 mg/m2 IV | Dilute in 250 mL normal saline or 5% dextrose in water (D5W)* and administer over one hour; special tubing needed.¶ | Days 1, 8, and 15 |
| Pretreatment considerations: |
| Emesis risk | - LOW (10 to 30% frequency of emesis).
- Refer to UpToDate topics on prevention of chemotherapy-induced nausea and vomiting in adults.
|
| Prophylaxis for infusion reactions | - Premedicate with dexamethasone plus both an H1 and an H2 receptor antagonist prior to paclitaxel administration.[2]
- Refer to UpToDate topics on infusion reactions to systemic chemotherapy.
|
| Vesicant/irritant properties | - Paclitaxel can cause significant tissue damage; avoid extravasation.
- Refer to UpToDate topics on extravasation injury from chemotherapy and other non-antineoplastic vesicants.
|
| Infection prophylaxis | - Primary prophylaxis with G-CSF is not generally warranted except in highest risk patients. In the original publication, febrile neutropenia was observed in only 2 of 30 patients during the first two cycles.[1]
- Refer to UpToDate topics on use of granulocyte colony stimulating factors in adult patients with chemotherapy-induced neutropenia and conditions other than acute leukemia, myelodysplastic syndrome, and hematopoietic cell transplantation.
|
| Dose adjustment for baseline liver or renal dysfunction | - A lower starting dose of paclitaxel may be needed in patients with liver impairment.
- Refer to UpToDate topics on chemotherapy hepatotoxicity and dose modification in patients with liver disease, conventional cytotoxic agents and chemotherapy hepatotoxicity and dose modification in patients with liver disease, molecularly targeted agents.
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| Monitoring parameters: |
- CBC with differential prior to treatment weekly during each cycle.
|
- Assess serum electrolytes prior to treatment weekly during each cycle.
|
- Assess renal and liver function prior to treatment weekly during each cycle.
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- Assess for neurologic toxicity prior to each treatment.
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| Suggested dose modifications for toxicity: |
| Myelotoxicity | - In the original protocol, new cycles were not started unless granulocyte count was >1500 cells/microL and platelets >100,000/microL.[1] For grade 3 or 4 toxicity, the weekly paclitaxel dose was reduced to 70 mg/m2, and then to 60 mg/m2 for a second episode of toxicity.[1]
|
| Peripheral neuropathy | - The development of severe symptomatic peripheral neuropathy requires a dose reduction of 20% for all subsequent courses of paclitaxel or may be cause for discontinuation of paclitaxel therapy.[2]
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| Other toxicity | - For any other grade 3 or 4 toxicity, paclitaxel dose was reduced to 70 mg/m2 and then to 60 mg/m2 for a second episode of that toxicity.[1]
|
| If there is a change in body weight of at least 10%, doses should be recalculated. |
