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Paclitaxel is one of the most active of all anti-cancer drugs, and shows particular activity against breast cancer. The drug has a very interesting history. It is actually a natural product, being derived from the bark of the Pacific yew tree. The drugs sat on the shelf of the National Cancer Institute in the United States for many years because it was thought that the allergic reactions that it caused were a major problem. It was rediscovered during the 1990's when it was realised that the allergic reactions could be effectively prevented using a combination of antihistamine drugs and the steroid drug dexamethasone. Dose schedules and combinations. Paclitaxel is used either as a single agent, or sometimes in combination with other chemotherapy drugs. For breast cancer it is most commonly given as a single agent, either once every three weeks, or weekly. It is given by intravenous injection over about 90 minutes.   The side-effects of paclitaxel depend on whether it is given weekly or third weekly (see table) The main side-effects are considered in detail elsewhere – just follow the links to find out more about each one and to read some tips on how to manage and minimize the symptoms. They include: Alopecia (hair loss). This depends on whether or not the paclitaxel is given weekly or third weekly. When given third weekly, paclitaxel always causes dramatic hair loss, including the scalp, eyebrows, eyelashes and other body hair. Hair loss occurs about 3-4 weeks after the first dose. When the weekly schedule is used hair loss is much more variable, often gradual and not usually complete. After treatment with paclitaxel has ended, normal hair growth should return. Nausea This is an uncommon side-effect of paclitaxel and often anti-nausea drugs are not required at all. It virually never occurs with the weekly schedule. Low white blood cells and infection Altered menstrual cycle and early menopause. Allergic reactions. These may consist of fever or chills; flushing of face; lower back or side pain accompanied by fever or chills; mild shortness of breath and occasional chest discomfort; skin rash or itching. Sometimes this occurs acutely during the infusion and often responds to a slowing down of the drip rate. We routinely give the antihistamine drugs ranitidine (“Zantac”) and loratidine prior to paclitaxel administration, together with intravenous dexamethasone. When the weekly schedule is used thiese drugs can be gradually omitted by the fifth week. Your chemotherapy nurse will supervise this. Muscle pains (“Myalgia”). This only occurs with the third-weekly schedule. Pain in joints or muscles, especially in the back and legs may begins 2 to 3 days after treatment and may last up to 5 days. It feels like “’flu” pain, and may need strong pain killers like Panadeine Forte. Loss of sensation (“Sensory neuropathy”) Paclitaxel causes reversible damage to the sensory nerves. This leads to “pins and needles” in the fingers and toes, and sometimes tenderness or odd burning sensations in the palms and soles, but especially the feet. It comes on after about two months of treatment, and may take as long as nine months to resolve after the treatment finishes. Not everyone gets this problem and some women seem much more sensitive to it than others. Palpitations (“Cardiac arrhythmias”) Rarely, paclitaxel may interfere with the conduction of electrical activity in the heart causing palpitations, or an altered heart rate. Your chemotherapy nurse will be monitoring you for this, but it is very uncommon and usually responds rapidly to cessation of the infusion. It is important that you notify your doctor of any pre-existing problem with heart rhythm, or to the presence of a cardiac pacemaker. | AC | CMF | Dose-intense Chemotherapy | Paclitaxel ('Taxol') | Vinorelbine ('Navelbine') | Capecitabine ('Xeloda') | FAC | FEC | Docetaxel ('Taxotere') | Taxotere, Adriamycin and Cyclophosphamide 'TAC' | | Tamoxifen | Chemotherapy for Breast Cancer | After Treatment - What Now? | Causes of Breast Cancer | Breast Cancer Myths | Family History | Herceptin | Femara, Arimidex, Aromasin | Adjuvant Chemotherapy | Zoladex and Stopping the ovaries | Stage, Grade, Receptors | Zometa, Aredia and Bonefos | Alopecia from Hormonal Therapy | New treatments | Lapatinib 'Tykerb' | | What's New | FAQ Page | Living with chemotherapy | Dietary Advice | Exercise | The Flu Vaccine | Insomnia | Marijuana | Alternative Medicine | Managing Menopause | Advice to Carers | Breast Cancer | Pain | Useful Tips | Chemotherapy: The What and How | MRI Screening | | Your Cancer Information | | Return Home | New Patients | Services and Clinics | Useful Links | Contact Us | Download Page | Cancer Information | |
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