Recommended Dosages and Treatment Regimens for Paclitaxel in Cancer Treatment
For cancer treatment, paclitaxel is most commonly administered at 175 mg/m² intravenously over 3 hours followed by carboplatin AUC 5-6 every 3 weeks for 6 cycles, which is considered a category 1 recommendation for ovarian, fallopian tube, and primary peritoneal cancers. 1
Standard Intravenous Regimens
Ovarian/Fallopian Tube/Primary Peritoneal Cancer
- Standard regimen: Paclitaxel 175 mg/m² IV over 3 hours followed by carboplatin AUC 5-7.5 IV over 1 hour on day 1, given every 3 weeks for 6 cycles (category 1) 1
- Dose-dense regimen: Paclitaxel 80 mg/m² IV over 1 hour on days 1,8, and 15 plus carboplatin AUC 6 IV over 1 hour on day 1, every 3 weeks for 6 cycles (category 1) 1
- Weekly regimen: Paclitaxel 60 mg/m² IV over 1 hour followed by carboplatin AUC 2 IV over 30 minutes, weekly for 18 weeks (category 1) 1, 2
- Alternative regimen: Docetaxel 60-75 mg/m² IV over 1 hour followed by carboplatin AUC 5-6 IV over 1 hour on day 1, every 3 weeks for 6 cycles (category 1) - consider for patients at high risk for neuropathy 1
Intraperitoneal (IP) Regimen for Optimally Debulked Stage III Disease
- Paclitaxel 135 mg/m² IV continuous infusion over 24 hours on day 1; IP cisplatin 75-100 mg/m² on day 2; IP paclitaxel 60 mg/m² on day 8 (maximum BSA 2.0 m²); repeat every 3 weeks for 6 cycles (category 1) 1
- Note: This regimen showed a 16-month survival advantage compared to standard IV therapy (65.6 vs. 49.7 months) in stage III optimally debulked disease 1
Breast Cancer
- Adjuvant treatment for node-positive breast cancer: Paclitaxel 175 mg/m² IV over 3 hours every 3 weeks for 4 courses administered sequentially to doxorubicin-containing chemotherapy 3
- Metastatic disease: Paclitaxel 175 mg/m² IV over 3 hours every 3 weeks 3, 4
- Weekly regimens (60-175 mg/m²) have shown promising results in advanced breast cancer with response rates up to 86% 5
Non-Small Cell Lung Cancer
- Paclitaxel 135 mg/m² IV over 24 hours followed by cisplatin 75 mg/m² every 3 weeks 3
AIDS-Related Kaposi's Sarcoma
- Paclitaxel 135 mg/m² IV over 3 hours every 3 weeks or 100 mg/m² IV over 3 hours every 2 weeks 3
- For classic Kaposi's sarcoma: 100 mg weekly IV has shown effectiveness 6
Treatment Duration
- Advanced ovarian cancer (stages II-IV): 6-8 cycles of chemotherapy 1
- Early-stage ovarian cancer: 3-6 cycles 1
- Breast cancer adjuvant therapy: 4 courses 3
Important Administration Considerations
Premedication Requirements
- All patients should receive premedication to prevent hypersensitivity reactions: 3
- Dexamethasone 20 mg PO approximately 12 and 6 hours before paclitaxel
- Diphenhydramine 50 mg IV 30-60 minutes before paclitaxel
- Cimetidine 300 mg or ranitidine 50 mg IV 30-60 minutes before paclitaxel
- For patients with advanced HIV disease: reduce dexamethasone to 10 mg PO 3
Toxicity Management
- Major dose-limiting toxicities include myelosuppression (particularly neutropenia) and peripheral neuropathy 7
- For patients who experience severe neutropenia (<500 cells/mm³ for a week or longer) or severe peripheral neuropathy, reduce subsequent doses by 20% 3
- Do not repeat courses until neutrophil count is at least 1,500 cells/mm³ and platelet count is at least 100,000 cells/mm³ 3
- For AIDS-related Kaposi's sarcoma, do not administer if baseline neutrophil count is <1,000 cells/mm³ 3
Toxicity Profiles of Different Regimens
- Docetaxel/carboplatin: Increased risk for neutropenia 1
- IV paclitaxel/carboplatin: Associated with sensory peripheral neuropathy 1
- Dose-dense paclitaxel: Associated with increased anemia 1
- IP paclitaxel/cisplatin: Associated with leukopenia, infection, fatigue, renal toxicity, abdominal discomfort, and neurotoxicity 1
Special Considerations
- Carboplatin administration requires monitoring for hypersensitivity reactions, which occur in 1-30% of patients, with risk increasing after cycle 7 (27-46%) 2
- Paclitaxel should be diluted in non-PVC containers and administered through polyethylene-lined administration sets to minimize exposure to DEHP plasticizer 3
- Paclitaxel pharmacokinetics are non-linear for short infusions (<6 hours) but not for longer infusions (>24 hours) 8
By following these evidence-based dosing regimens and administration guidelines, clinicians can optimize treatment outcomes while managing toxicities for patients receiving paclitaxel-based chemotherapy.