II. Indications

  1. FDA Approved
    1. Breast Cancer
    2. Kaposi Sarcoma (AIDs related)
    3. Non-Small Cell Lung Cancer
    4. Ovarian Cancer
  2. Off-Label
    1. Head and neck cancer (advanced)
    2. Gastrointestinal Tract Adenocarcinoma (gastric, esophageal, colon)
    3. Non-Hodgkin Lymphoma
    4. Pancreatic Cancer
    5. Polycystic Kidney Disease
    6. Prostate Cancer (Hormone refractory)
    7. Transitional Cell Carcinoma (urothelial cancer)
    8. Uterine Cancer

III. Contraindications

  1. Polyoxyethylated Castor Oil (Cremophor EL) allergy

IV. Mechanism

  1. See Mitotic Inhibitor Chemotherapy
  2. Paclitaxel is a Taxane antineoplastic agent
    1. Derived from extract of the Pacific yew tree (Taxus brevifolia)
  3. Paclitaxel has antineoplastic activity as a an antitubulin agent
    1. Binds and stabilizes tubulin
    2. Inhibits microtubule disassembly
    3. Results in cell cycle arrest in G2/M phase
  4. Paclitaxel induces apoptosis
    1. Binds and blocks apoptosis inhibitor Protein Bcl-2 (B-cell Leukemia 2)

V. Medications

  1. Paclitaxel injection solution
    1. Doses available from 30 mg/5 ml to 300 mg/50 ml

VI. Dosing

  1. See other references for disease specific dosing protocols

VII. Adverse Effects

  1. Hypersensitivity Reaction (including Anaphylaxis)
  2. Myelosuppression (Bone Marrow suppression) with Neutropenia
  3. Peripheral Neuropathy
  4. Future impaired fertility
  5. Alopecia
  6. Nausea
  7. Myalgias
  8. Cardiac conduction abnormalities

VIII. Safety

  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters)
    1. Use reliable Contraception
  3. Monitoring
    1. Complete Blood Count

IX. Drug Interactions

  1. Agents that increase Paclitaxel levels
    1. Diazepam
    2. Estradiol
    3. Felodipine
    4. Ketoconazole

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