Can paclitaxel cause diarrhea in cancer patients?

Paclitaxel and Diarrhea

Yes, paclitaxel can cause diarrhea in cancer patients, with the incidence and severity varying significantly based on dosing schedule and combination therapy. 1

Incidence Based on Dosing Schedule

The prevalence of diarrhea with paclitaxel is highly schedule-dependent 1:

• 24-hour infusion (175-225 mg/m²): All-grade diarrhea occurs in approximately 39% of patients, with 3% experiencing grade 3-4 severity 1
• Weekly schedules: Grade 3 diarrhea occurs in 3-7% of patients 1
• Single-agent paclitaxel: Diarrhea reported in 38% of all patients, typically mild to moderate 2

Severity and Clinical Significance

The gastrointestinal toxicity from paclitaxel is generally mild to moderate, but severe complications can occur 2:

• Most manifestations are mild to moderate in severity 2
• Cases of severe enteritis and colitis have been reported 1
• Neutropenic enterocolitis (typhlitis) has been observed, even with G-CSF support 2
• Intestinal obstruction, intestinal perforation, pancreatitis, and ischemic colitis are rare but documented complications 2

Special Populations and Risk Factors

AIDS-related Kaposi's sarcoma patients experience significantly higher rates of diarrhea 2:

• Diarrhea reported in 79% of patients receiving paclitaxel 100 mg/m² every 2 weeks 2
• These patients require lower dose intensity and more aggressive supportive care 2

Clostridium difficile-associated diarrhea (CDAD) is an important consideration 3:

• CDAD occurs in approximately 2.2% of patients receiving standard-dose paclitaxel regimens 3
• Risk increases to 20% in patients receiving high-dose regimens 3
• This etiology should be considered early in patients presenting with gastrointestinal toxicity after paclitaxel treatment 3

Combination Therapy Considerations

When paclitaxel is combined with cisplatin, diarrhea incidence increases 2:

• The incidence of any-grade diarrhea is higher compared to single-agent paclitaxel 2
• However, there is no significant difference in severe diarrhea rates between combination and single-agent therapy 2
• Nausea and vomiting also occur more frequently with combination therapy 2

Comparison to Other Taxanes

Nab-paclitaxel (albumin-bound paclitaxel) has similar gastrointestinal toxicity 1:

• Any-grade diarrhea prevalence up to 44% 1
• Notably, no grade 3 events reported 1

Clinical Pitfalls and Monitoring

Key considerations for managing paclitaxel-related diarrhea:

• Mucositis is more frequent with 24-hour infusions compared to 3-hour infusions 2
• One-third of Kaposi's sarcoma patients may have pre-existing diarrhea before treatment initiation 2
• Dehydration requiring hospitalization can occur, particularly with severe cases 3
• Consider C. difficile testing in patients with persistent or severe diarrhea, especially those on high-dose regimens 3