Important Facts About Taxol

Taxol (paclitaxel) is one of the most commonly used and effective chemotherapy drugs for breast cancer. One of the main reasons why is that it is effective for all stages of the disease. It's among several medications in a class called taxanes, and it's also used for other forms of cancer, such as ovarian cancer.

If you or someone you know is prescribed Taxol (or Onxal, another brand name for paclitaxel), there are some important things to know about this powerful drug.

Taxol is an especially versatile drug. It is used for breast cancer in the early stages as well as for metastatic breast cancer. Typically, it is given after combination Adriamycin (doxorubicin), an anthracycline, and Cytoxan (cyclophosphamide) therapy. It's also used prior to surgery in cases when it is necessary to shrink a tumor before it's removed (neoadjuvant chemotherapy).

Besides breast cancer and ovarian cancer, Taxol can be used to treat several other types of cancer, including lung cancer and Kaposi's sarcoma, a rare type of skin cancer that affects people with AIDS.

The chemotherapy class taxanes includes the drug Taxotere (docetaxel) as well as Taxol.

Tumor cells grow by a process called mitosis, the clinical name for cell division. Taxol is a mitotic inhibitor: It targets rapidly growing cancer cells by getting inside them and attaching to the scaffold-like structures of the cells called microtubules. In this way, the drug prevents cancer cells from dividing.

You will be monitored regularly while you are taking Taxol to assess your response to therapy. Periodic blood work to monitor your complete blood count (CBC), as well as the function of other organs (such as your kidneys and liver), will also be ordered by your doctor.  

Taxol is a clear, colorless fluid that's mixed with Cremophor EL (polyoxyethylated castor oil) and given by infusion—in other words, it's administered directly into a vein. It is thick and sticky, so a pump is necessary to properly infuse it. As such, you'll have to go to a hospital or clinic to receive it.

It can be given as high-dose chemo, once every two or three weeks, or in low doses once a week. In some cases, Taxol is given slowly over the course of 24 hours.

The amount of Taxol you are prescribed depends on many factors, including your height and weight, your general health, and the type of cancer or condition being treated.

A doctor or nurse must administer Taxol; if not administered properly, it can cause tissue damage.

Medications such as Benadryl (diphenhydramine) are given before and during infusion of Taxol to reduce the risk of an allergic reaction.

Most people tolerate Taxol well, especially in low doses. It does have side effects, however, which include:

• Peripheral neuropathy (nerve damage)
• Anemia 
• Neutropenia 
• Thrombocytopenia (a low platelet count)
• Bone and muscle aches (Neulasta and Neupogen also frequently cause bone pain)
• Hair loss
• Fatigue
• Nausea
• Vomiting
• Mild diarrhea
• Mucositis (irritation of mucous membrane inside the mouth)
• Amenorrhea (absence of menstruation)

There are ways to prevent some of the problems these side effects can cause. Before you begin treatment with Taxol, your doctor will probably have you take supplements of an amino acid called L-glutamine to reduce your risk of neuropathy. It is also become increasingly common to use you injections of either Neupogen (filgrastim) or Neulasta (pegfilgrastim) to boost white blood cell counts. These must be given at least 24 hours after your chemotherapy infusion has been completed, but early enough to stimulate formation of white blood cells before they hit their lowest point (called the nadir).

Furthermore, to avoid risky interactions, you will be advised not to drink alcohol while you're being treated with Taxol, and to avoid medications that include aspirin.

Furthermore, to avoid risky interactions, you will be advised not to drink alcohol while you're being treated with Taxol, and to avoid medications that include aspirin.

Most side effects of chemotherapy resolve rapidly after treatment is completed, although some long-term side effects of chemotherapy may persist. In particular, peripheral neuropathy may sometimes be permanent, and fatigue may sometimes take years to fully improve.

Taxol is a pregnancy category D drug, meaning it can harm a developing fetus. It should not be used by pregnant women; if you are not pregnant and are sexually active, you'll have to use birth control while you are on Taxol. Taxol can be passed through breast milk, so you will not be able to breastfeed.

Since chemotherapy drugs compromise the immune system, some vaccines (live vaccines) are not recommended while you are undergoing Taxol treatment. Killed vaccines (such as the flu shot, but not the oral preparation) are, however, often recommended. That said, vaccines may not work as well as usual when you are receiving chemotherapy.

You will be susceptible to infections while on Taxol, which can often become very serious—even life-threatening. This risk may be present even if you are also receiving Neulasta or Neupogen. Call your doctor immediately if you develop a fever, chills, pain, or notice redness or swelling at the infusion site.

Some people may have an allergic reaction to Taxol or to Cremophor EL, and therefore should avoid this drug.

As with any form of chemotherapy, Taxol can take a toll on your energy. Try to eat healthily, exercise when you can, and get adequate rest during treatment. Learn to ask for, and accept help. Keep in mind that one of the most common complaints of loved ones of people coping with cancer is a sense of helplessness. Allowing your loved one to help you may not only help deal with the fatigue of treatment, but help them better cope as well.