Important Facts About Taxol

Taxol (paclitaxel) is a commonly used chemotherapy drug used to treat cancer. It is part of a medication class called taxanes.

Taxol is one of the most effective and commonly used drugs for breast cancer treatment and it can be used in all stages of the disease. Sometimes it can be used to treat other types of cancer, like ovarian cancer. 

If you or someone you know has been prescribed this drug (or Onxal, another brand name for paclitaxel), there are some essential things to know about it.

This article explains how Taxol works, along with the dosage, side effects, and risks.

When Taxol Is Used

The chemotherapy class of taxanes include the drugs Taxotere (docetaxel) and paclitaxel. Taxol is a versatile drug used to treat breast cancer. It can be used in both early-stage breast cancer and metastatic breast cancer (cancer that has spread to other organs).

Typically, oncologists prescribe it as part of combination treatment that includes other chemotherapy drugs such as:

• Adriamycin (doxorubicin)
• Cytoxan (cyclophosphamide)
• 5-FU (5-fluorouracil)
• Xeloda (capecitabine)
• Paraplatin (carboplatin)

While there are standard chemotherapy combinations, your healthcare team will customize your treatment plan for you depending on the characteristics of your cancer and your overall health.

Doctors also use Taxol as part of 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 disproportionately affects people with HIV and AIDS.

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How Taxol Works

All cells, including tumor cells, multiply by a process called mitosis, the scientific name for cell division. Taxol works as a mitotic inhibitor, targeting rapidly dividing cancer cells to prevent the tumor from growing. It does so by getting inside the cells and attaching to scaffold-like structures called microtubules, interfering with their function.

Taxol can affect any of the rapidly dividing cells of your body; this is what causes many of the side effects of chemotherapy treatments. 

Your oncologist will monitor you regularly while you're taking Taxol to assess your response to therapy. You should expect intermittent tests to check on the tumor size and location. Typically, you will have routine blood work including a complete blood count (CBC) and a comprehensive metabolic panel (CMP) to monitor your kidney and liver function.

Preparation and Dosing

Taxol is a clear, colorless fluid that is mixed with Cremophor EL (polyoxyethylated castor oil) and given by intravenous (in a vein) infusion. You will typically receive your infusion at a hospital or clinic.

Doctors can prescribe Taxol in several ways, including:

• Once every two or three weeks
• Once a week
• Slowly over 24 hours

Your Taxol dose depends on many factors, including:

• Your height
• Your weight
• Your general health
• The type of cancer you have

A healthcare provider must administer Taxol; if not administered properly, it can cause tissue damage, typically at the IV site.

You may be given medications like Benadryl (diphenhydramine) before your infusion to reduce the risk of an allergic reaction.

Side Effects

Most people tolerate Taxol well, especially in low doses. However, it does have side effects, including:

• Peripheral neuropathy (nerve damage)
• Anemia (low red blood cells)
• Neutropenia (low white blood cells)
• Bone and muscle aches
• Hair loss
• Fatigue
• Nausea
• Vomiting
• Mild diarrhea
• Amenorrhea (absence of menstruation)

Preventing Side Effects

There are ways to minimize and prevent some of the side effects.

Chemotherapy reduces the effectiveness of the bone marrow in producing new white blood cells, red blood cells, and platelets. A low white blood cell count makes your immune system less effective and puts you at a higher risk for infections.

Neupogen (filgrastim) and Neulasta (pegfilgrastim) are two injectable medications given to boost white blood cell production and to help prevent infections. 

• Neupogen is given daily until the white blood cell counts improve.
• Neulasta is only given once and continues to stimulate the bone marrow from a single dose.

The choice between Neupogen and Neulasta can depend on factors such as your health and your insurance coverage. 

The timing of these immune-stimulating medications is important because ideally, they should start making white blood cells before they hit their lowest point (called the nadir). The first dose is usually given at least 24 hours after your chemotherapy infusion is complete.

Most side effects of chemotherapy resolve rapidly after treatment concludes, 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 improve fully.

Risks and Contraindications

To avoid risky interactions, your medical team may advise you not to drink alcohol. You may also receive recommendations to avoid certain medications if you take any medications that could interact with Taxol.

Taxol comes with some risks and is not recommended for everyone.

Pregnancy and Lactation

If taken during pregnancy, Taxol can potentially harm a developing fetus. Therefore, you should not receive Taxol while pregnant. Due to Taxol's risk during pregnancy, your provider will likely recommend birth control while you are taking Taxol if you are a sexually active female of child-bearing age.

In addition, Taxol can pass through to breast milk. It is generally recommended that you avoid breastfeeding while receiving Taxol and for several weeks after you complete your treatment.

Vaccines

Vaccines may not be as effective when you are receiving chemotherapy. Due to your weakened immune system, your body may not produce enough of an immune response to get the benefit from the vaccine. Most of the time, vaccines are delayed and given after cancer treatment is complete.

Since chemotherapy drugs compromise the immune system, live vaccines are generally not recommended while undergoing Taxol treatment. A weakened immune system during treatment may make you more susceptible to getting an infection from the vaccine.

The flu vaccine FluMist is a nasal spray with a weakened form of the influenza virus. This is one of the live vaccines that should be avoided in people with compromised immune systems—including those receiving Taxol.

However, most vaccines (such as flu shots or COVID vaccines) are safe during chemotherapy. Inactivated vaccines use pre-killed pathogens (germs), and many vaccines use virus-like substances to stimulate the immune system.

Infections

You will be susceptible to infections while taking Taxol, which can often become very serious and even life-threatening. Chemotherapy reduces the production of white blood cells called neutrophils and leaves your immune system in a weakened state. A low neutrophil count is called neutropenia. A risk of infection may be present even if you receive Neulasta or Neupogen.

Due to this increased risk, call your healthcare provider immediately if you develop a fever, chills, pain, or notice redness or swelling at the infusion site. Neutropenic fevers are considered a medical emergency.

Allergic Reaction

Some people may have an allergic reaction to Taxol or Cremophor EL, and therefore should avoid this drug. Your healthcare team will monitor you closely while you receive Taxol and may give treatment if you develop a reaction.

Summary

Taxol is a chemotherapy medication that treats breast cancer, ovarian cancer, head and neck cancer, lung cancer, sarcomas and other malignancies. It is common to experience side effects like vomiting, hair loss, fatigue, and nerve damage while taking Taxol. Some of these side effects can be prevented or lessened through supplements and medications. 

Chemotherapy drugs are powerful, so your provider will discuss the risks and benefits with you prior to giving you the drug. People who are pregnant, breastfeeding, or allergic to Taxol should not take this drug. In addition, while undergoing treatment, you are more susceptible to serious infections.

A Word From Verywell

As with any form of chemotherapy, Taxol can take a toll on your energy. Try to eat healthily, exercise when possible, and get adequate rest during treatment. In addition, learn to ask for and accept help. 

Finally, keep in mind that one of the most common complaints from people who have a loved one coping with cancer is a sense of helplessness. Therefore, allowing your loved one to lend a hand may help both of you.