Patient care issues: the management of paclitaxel-related toxicities

At the low-to-moderate doses that are recommended, paclitaxel is a well-tolerated drug. Although adverse reactions do occur, most of these are manageable and do not have a long-lasting effect on the patients' quality of life. The starting dose of paclitaxel, as approved by the Food and Drug Administration for refractory ovarian cancer, is 135 mg/m2. A slightly higher dose (175 mg/m2) is being investigated for heavily pretreated patients with metastatic breast cancer. In the investigational setting, the highest dose that may safely be administered when paclitaxel is used as a single agent is 250 mg/m2 for minimally pretreated patients. If G-CSF is also given, the same dose may safely be administered to heavily pretreated patients. When paclitaxel is administered in combination with cisplatin, a dose of 135 mg/m2 may safely be given prior to cisplatin, which is administered at a dose of 75 mg/m2. These dose levels may be increased when G-CSF is also used. Dose modifications should be considered only in patients who experience severe neutropenia or neurotoxicity. Patients who received high doses of paclitaxel in Phase II trials frequently required dose reductions. However, when the drug is administered at the recommended dose of 135 mg/m2, neutropenia does not often necessitate further dose reduction. Hematopoietic growth factors, such as G-CSF, seem to be helpful in preventing prolonged grade IV and febrile neutropenia, and in avoiding treatment delays for longer than one week.(ABSTRACT TRUNCATED AT 250 WORDS)