What is the standard dosage of Paclitaxel (Taxol) for breast cancer treatment?

From the Guidelines

The standard paclitaxel dosage for breast cancer is 175 mg/m² intravenously over 3 hours every 3 weeks for 4 cycles, or in a dose-dense schedule of 80 mg/m² weekly for 12 weeks, as supported by the most recent guidelines 1. When considering the treatment of breast cancer, it's essential to weigh the benefits and risks of different paclitaxel regimens.

• The dose-dense schedule has shown significant improvements in disease-free survival (DFS) and overall survival (OS) compared to the every-3-weeks schedule, particularly in patients with triple-negative breast cancer (TNBC) 1.
• The selection of paclitaxel dosage should be based on individual patient factors, including prior treatment, comorbidity, and expected toxicities.
• Premedication is crucial to prevent hypersensitivity reactions, and patients should be monitored for common side effects such as neutropenia, peripheral neuropathy, alopecia, myalgia, and arthralgia.
• Dose adjustments may be necessary based on toxicities, particularly neutropenia and neuropathy, to ensure optimal treatment outcomes. The most recent study 1 provides the highest quality evidence for the standard paclitaxel dosage, and its findings should be prioritized in clinical decision-making.
• Key points to consider when administering paclitaxel include:
  • Dose: 175 mg/m² every 3 weeks or 80 mg/m² weekly
  • Administration: intravenously over 3 hours
  • Premedication: essential to prevent hypersensitivity reactions
  • Monitoring: regular monitoring for common side effects and toxicities By following these guidelines and considering individual patient factors, healthcare providers can optimize paclitaxel treatment for breast cancer patients, prioritizing morbidity, mortality, and quality of life outcomes.

From the FDA Drug Label

For patients with carcinoma of the breast, the following is recommended (see CLINICAL STUDIES: Breast Carcinoma section):

1. For the adjuvant treatment of node-positive breast cancer, the recommended regimen is paclitaxel, at a dose of 175 mg/m2 intravenously over 3 hours every 3 weeks for 4 courses administered sequentially to doxorubicin-containing combination chemotherapy
2. After failure of initial chemotherapy for metastatic disease or relapse within 6 months of adjuvant chemotherapy, paclitaxel at a dose of 175 mg/m2 administered intravenously over 3 hours every 3 weeks has been shown to be effective

The standard paclitaxel dosage for breast cancer is 175 mg/m2 administered intravenously over 3 hours every 3 weeks.

• For adjuvant treatment of node-positive breast cancer, the recommended regimen is 4 courses administered sequentially to doxorubicin-containing combination chemotherapy.
• For metastatic disease or relapse within 6 months of adjuvant chemotherapy, paclitaxel has been shown to be effective at this dose and schedule 2

From the Research

Standard Paclitaxel Dosage for Breast Cancer

• The standard paclitaxel dosage for breast cancer varies depending on the treatment schedule and setting 3, 4, 5.
• In metastatic breast cancer, paclitaxel is often administered at a dose of 135-250 mg/m2 over 3 or 24 hours once every 3 weeks 3.
• Weekly dosing of paclitaxel at 60-175 mg/m2 has also shown promising results in phase I/II trials 3, 4.
• In one study, weekly paclitaxel at 175 mg/m2 for 6 weeks, followed by a 2-week break, resulted in an overall response rate of 86% in patients with metastatic and locally advanced breast cancer 4.
• Another study compared two schedules of paclitaxel administration: a 1-hour infusion and a 3-day, divided dose schedule, with total doses of 135 mg/m2 and 200 mg/m2 5.
• The study found that both schedules were well tolerated, but grade 3 and 4 leukopenia was more common with the 3-day schedule when paclitaxel 200 mg/m2 was administered 5.

Nab-Paclitaxel Dosage for Breast Cancer

• Nab-paclitaxel is approved for the treatment of metastatic breast cancer at a dose of 260 mg/m2 every 3 weeks 6.
• However, weekly dosing of nab-paclitaxel at 100-150 mg/m2 has also shown efficacy in clinical trials 6, 7.
• In one study, neoadjuvant therapy with nab-paclitaxel at 100 mg/m2 on days 1,8, and 15, combined with carboplatin and trastuzumab, resulted in a pathologic complete response rate of 54% in patients with locally advanced HER2-positive breast cancer 7.