From the Guidelines
The recommended dose of paclitaxel when used concurrently with radiation therapy and carboplatin is 45 mg/m² once a week, as evidenced by the RTOG 0617 trial 1. This dose is administered weekly, in combination with carboplatin at an AUC of 2, during the course of radiation therapy, which typically lasts 5-7 weeks.
- The radiation therapy dose should be 60 Gy in 30 fractions, as higher doses have been associated with inferior outcomes and increased toxicity 1.
- It is crucial to monitor patients for potential side effects, including myelosuppression, peripheral neuropathy, and hypersensitivity reactions, during treatment with this regimen.
- Premedication with dexamethasone, diphenhydramine, and an H2 blocker should be administered before each paclitaxel infusion to prevent hypersensitivity reactions.
- The use of this lower weekly dose of paclitaxel, compared to single-agent treatment, is intended to enhance radiation sensitivity while maintaining tolerability, as concurrent chemoradiation increases toxicity 1.
From the Research
Paclitaxel Dose with Radiation Therapy and Carboplatin
- The recommended paclitaxel dose when used concurrently with radiation therapy and carboplatin is not explicitly stated in one specific study, but various studies provide insight into the dosing regimens used in clinical trials 2, 3, 4, 5.
- In one study, patients received concomitant paclitaxel (45 mg/m2) and carboplatin (AUC 2) weekly with radiotherapy 2.
- Another study used paclitaxel 50 mg/m2 weekly over 1 hour and carboplatin at (area under the curve) AUC 2 weekly, along with radiation therapy of 66 Gy in 33 fractions 4.
- A different study administered paclitaxel 40 mg/m2 intravenously for 1 hour, and carboplatin of 1.5 AUC/cycle after administration of paclitaxel on specific days, concurrent with 3D-CRT 5.
- These studies suggest that the paclitaxel dose can vary, but common regimens include 40-50 mg/m2 weekly, given concurrently with carboplatin and radiation therapy 3, 4, 5.
Rationale for Dosing Regimens
- The choice of paclitaxel dose may depend on factors such as the specific cancer type, patient performance status, and the presence of any comorbidities 6.
- The dosing regimens used in these studies were likely chosen based on the results of previous clinical trials and the desire to minimize toxicity while maximizing efficacy 2, 3, 4, 5.
- Further research is needed to determine the optimal paclitaxel dose for use with radiation therapy and carboplatin in the treatment of non-small cell lung cancer 2, 3, 4, 5.