| 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 topic on "Prevention and treatment 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 topic on "Infusion reactions to systemic chemotherapy".
|
| Vesicant/irritant properties | - Paclitaxel can cause significant tissue damage; avoid extravasation.
- Refer to UpToDate topic 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 topic 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 topic 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".
|
| 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.
|
- Assess for neurologic toxicity prior to each treatment.
|
| 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]
|
| 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. |
