Paclitaxel


Article Author:
Maela Farrar


Article Editor:
Tibb Jacobs


Editors In Chief:
Kranthi Sitammagari
Mayank Singhal


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Trevor Nezwek
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes


Updated:
12/29/2018 7:27:10 PM

Indications

FDA approved indications:

  • Adjuvant treatment for node-positive breast cancer [1]
  • Treatment of metastatic breast cancer after failure of combination chemotherapy that included an anthracycline [2]
  • Treatment of metastatic breast cancer that relapsed within six months of adjuvant chemotherapy that included an anthracycline [3][4]
  • Treatment of AIDS-related Kaposi sarcoma (second line)[5]
  • Treatment of non-small cell lung cancer in combination therapy with cisplatin in patients who are not candidates for surgery and/or radiation therapy[6]
  • Treatment of ovarian cancer in combination with cisplatin[7][8]
  • Subsequent therapy for treatment of advanced ovarian cancer in combination with cisplatin[9][10]

Non-FDA approved indications:

  • Treatment of metastatic or advanced bladder cancer in combination therapy with gemcitabine[11][12]
  • Treatment of advanced cervical cancer in combination with topotecan, bevacizumab, and/or cisplatin[13][14][15]
  • Preoperative management of esophageal and gastric cancers in combination with carboplatin and radiation therapy[16]
  • Treatment of advanced head and neck cancer in combination with cisplatin[17]
  • Neoadjuvant treatment in penile cancer with bulky regional lymph node metastases[18]
  • Treating relapsed or refractory small cell lung cancer[19][20]
  • Treatment of advanced or unresectable angiosarcoma [21][22]
  • Treatment of relapsed or refractory testicular germ cell tumors in combination with gemcitabine and oxaliplatin or ifosfamide and cisplatin[23][24][25]
  • Treatment of advanced thymoma/thymic carcinoma in combination with carboplatin[26]
  • Treatment of unknown primary adenocarcinoma in combination with carboplatin and/or etoposide [27][28]
  • Treatment of endometrial carcinoma[29]
  • Treatment of metastatic or unresectable esophageal cancer[30]
  • Treatment of metastatic or unresectable gastric cancer[31]
  • Treatment of melanoma[32]
  • Treatment of anaplastic thyroid cancer[33]

Mechanism of Action

Paclitaxel is an antimicrotubule agent. It promotes the assembly of microtubules by enhancing the action of tubulin dimers and stabilizing current microtubules while inhibiting their disassembly. Due to the stability of the microtubules, late G2 phase stops and cell replication inhibited. Paclitaxel may also distort mitotic spindles causing the chromosomes to break.[34]

Administration

Paclitaxel is available as an IV formula that is infused over 3 or 24 hours depending on the indication or protocol. Certain off-label protocols use a 1-hour infusion, as well as off-label intraperitoneal use. Paclitaxel infusion should be through a 0.22-micron in-line filter and polyethylene-lined administration set (non-PVC).[35] If the drug is part of a combination chemotherapy regimen, the order may vary by regimen, and it is important to refer to a protocol for the recommended sequence. Patients may also be premedicated with dexamethasone, diphenhydramine, cimetidine, or ranitidine prior to the infusion.[36][37][38] Because paclitaxel is such a potent irritant, care to avoid extravasation must be taken.  Caution with needle and catheter position is essential during the administration of the medication.  

Adverse Effects

Paclitaxel has a black box warning for hypersensitivity reactions and bone marrow suppression. Patients should be premedicated with corticosteroids, diphenhydramine, and H2 antagonists prior to infusion to avoid anaphylaxis and severe hypersensitivity reactions. The recommendation is for dexamethasone at 20 mg IV or orally (10 mg if the patient has advanced HIV) at 12 and 6 hours before the paclitaxel dose. Diphenhydramine should be administered 30 to 60 minutes prior to the dose at 50 mg IV. Cimetidine 300 mg, famotidine 20 mg, or ranitidine 50 mg would all be appropriate choices to be administered IV at 30 to 60 minutes prior to the dose. Severe hypersensitivity reactions would include dyspnea requiring bronchodilators, hypotension requiring treatment, angioedema, and/or generalized urticaria. In cases of serious hypersensitivity reaction, stop the infusion and discontinue paclitaxel. Minor hypersensitivity reactions do not require treatment to be interrupted or discontinued. Minor hypersensitivity reactions would include flushing, dyspnea, hypotension, skin reactions, or tachycardia.[39][40]

The most prevalent side effects of paclitaxel are alopecia, nausea and vomiting, mucositis, neutropenia, leukopenia, anemia, hypersensitivity reactions, arthralgia, myalgia, and weakness. Peripheral neuropathy is another common side effect and patients with preexisting neuropathies may have an increased risk. The dose should be reduced by 20% for patients who develop severe neuropathy.[41]

Other less common side effects include flushing, edema, hypotension, skin rash, stomatitis, thrombocytopenia, hemorrhage, increased serum alkaline phosphatase and AST, local injection site reaction, increased serum creatinine, along with many more. Injection site reactions generally are mild (erythema, tenderness, skin discoloration, or swelling) and tend to occur more often with an extended infusion duration, like 24 hours for example. It is worth noting that delays of injection site reactions can extend from 7 to 10 days. Patients may also experience infusion-related hypotension, bradycardia, and/or hypertension. Due to that concern, the recommendation is that the patient's vital signs undergo frequent monitoring, especially during the first hour of infusion.[42] 

Contraindications

Due to the black box warning for hypersensitivity reactions and bone marrow suppression, paclitaxel should not be given to patients who have had a severe hypersensitivity reaction with paclitaxel, patients with solid tumors who have a baseline neutrophil count of less than 1500 cells/mm^3, or patients with AIDS-related Kaposi sarcoma if the baseline neutrophil count is less than 1000 cells/mm^3. Bone marrow suppression is dose dependent and is a dose-limiting toxicity. If it occurs, future doses should be reduced by 20% for severe neutropenia and consider supportive therapy (growth factor treatment).[43]

Monitoring

The infusion site should be monitored for extravasation. If it occurs, stop the infusion immediately and disconnect, but leave the needle/cannula in place. The extravasated solution should be gently aspirated, but it is crucial not to flush the line. Remove the needle/cannula, initiate the antidote, remove that needle/cannula, and elevate the extremity. The data conflicts over whether to use warm or cold compresses.[44] Patients should also be monitored for a severe hypersensitivity reaction. Although every patient should be premedicated to prevent one from happening, some patients may still experience one which would warrant treatment discontinuation. 

Toxicity

Hyaluronidase is the antidote for paclitaxel and is commonly used for the treatment of extravasation. If the needle/cannula is still in place, administer 1 to 6 mL into the existing IV line. If the needle/cannula is no longer inserted, the hyaluronidase may be injected subcutaneously clockwise around the area of extravasation. This procedure may be repeated several times over the next 3 to 4 hours.[45]

Enhancing Healthcare Team Outcomes

Successful interprofessional teamwork and communication assure that all patients receive their appropriate dose and regimen based on FDA guidelines or hospital protocol. Oncologists should thoroughly evaluate the patient and select an appropriate treatment regimen based on guidelines and patient-specific factors. Nurses should be made aware of the signs and symptoms of hypersensitivity reactions to paclitaxel along with extravasation management. Pharmacists should examine the patient’s current and complete drug regimen and make sure there are no interactions, as paclitaxel has many that could make treatment modifications necessary. These are just a few examples of healthcare professionals that may have responsibilities for patients taking paclitaxel. Naturally, roles tend to overlap in various health professions, but every healthcare professional provides a vital role that benefits the patient to the highest degree. (Level V)


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Paclitaxel - Questions

Take a quiz of the questions on this article.

Take Quiz
What is the mode of action of paclitaxel?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following acts as a spindle poison in treating ovarian cancers?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What kind of drug is paclitaxel?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the mode of action of paclitaxel?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which one of the following drugs specifically affects cells undergoing mitosis?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following medications affects microtubule formation?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following medications inhibits microtubule formation?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is the best description of paclitaxel?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What type of drug is paclitaxel?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which is not appropriate when dispensing injectable paclitaxel?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following medications is not an appropriate choice for pre-medicating a patient receiving paclitaxel?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which adverse effect should result in a decreased dose of paclitaxel?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is not the appropriate course of action when extravasation of paclitaxel occurs?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Paclitaxel - References

References

Loesch D,Greco FA,Senzer NN,Burris HA,Hainsworth JD,Jones S,Vukelja SJ,Sandbach J,Holmes F,Sedlacek S,Pippen J,Lindquist D,McIntyre K,Blum JL,Modiano MR,Boehm KA,Zhan F,Asmar L,Robert N, Phase III multicenter trial of doxorubicin plus cyclophosphamide followed by paclitaxel compared with doxorubicin plus paclitaxel followed by weekly paclitaxel as adjuvant therapy for women with high-risk breast cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2010 Jun 20     [PubMed]
Akerley W,Sikov WM,Cummings F,Safran H,Strenger R,Marchant D, Weekly high-dose paclitaxel in metastatic and locally advanced breast cancer: a preliminary report. Seminars in oncology. 1997 Oct     [PubMed]
Johnson DH,Paul D,Hande KR, Paclitaxel, 5-fluorouracil, and folinic acid in metastatic breast cancer: BRE-26, a phase II trial. Seminars in oncology. 1997 Feb     [PubMed]
Panagos GE, Treatment of advanced and relapsing breast cancer with a combination of paclitaxel and mitoxantrone. South-Central Hellenic Oncology Group. Seminars in oncology. 1997 Feb     [PubMed]
Gill PS,Tulpule A,Espina BM,Cabriales S,Bresnahan J,Ilaw M,Louie S,Gustafson NF,Brown MA,Orcutt C,Winograd B,Scadden DT, Paclitaxel is safe and effective in the treatment of advanced AIDS-related Kaposi's sarcoma. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 1999 Jun     [PubMed]
Ohe Y,Ohashi Y,Kubota K,Tamura T,Nakagawa K,Negoro S,Nishiwaki Y,Saijo N,Ariyoshi Y,Fukuoka M, Randomized phase III study of cisplatin plus irinotecan versus carboplatin plus paclitaxel, cisplatin plus gemcitabine, and cisplatin plus vinorelbine for advanced non-small-cell lung cancer: Four-Arm Cooperative Study in Japan. Annals of oncology : official journal of the European Society for Medical Oncology. 2007 Feb     [PubMed]
McGuire WP,Hoskins WJ,Brady MF,Kucera PR,Partridge EE,Look KY,Clarke-Pearson DL,Davidson M, Comparison of combination therapy with paclitaxel and cisplatin versus cyclophosphamide and cisplatin in patients with suboptimal stage III and stage IV ovarian cancer: a Gynecologic Oncology Group study. Seminars in oncology. 1997 Feb     [PubMed]
Armstrong DK,Bundy B,Wenzel L,Huang HQ,Baergen R,Lele S,Copeland LJ,Walker JL,Burger RA, Intraperitoneal cisplatin and paclitaxel in ovarian cancer. The New England journal of medicine. 2006 Jan 5     [PubMed]
Nardi M,Aloe A,De Marco S,Cognetti F,Iacovelli A,Atlante G,Calabresi F, Paclitaxel as salvage therapy in advanced pretreated ovarian cancer: a phase II study. American journal of clinical oncology. 1997 Jun     [PubMed]
Mayerhofer K,Kucera E,Zeisler H,Speiser P,Reinthaller A,Sevelda P, Taxol as second-line treatment in patients with advanced ovarian cancer after platinum-based first-line chemotherapy. Gynecologic oncology. 1997 Jan     [PubMed]
Meluch AA,Greco FA,Burris HA 3rd,O'Rourke T,Ortega G,Steis RG,Morrissey LH,Johnson V,Hainsworth JD, Paclitaxel and gemcitabine chemotherapy for advanced transitional-cell carcinoma of the urothelial tract: a phase II trial of the Minnie pearl cancer research network. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2001 Jun 15     [PubMed]
Sternberg CN,Calabrò F,Pizzocaro G,Marini L,Schnetzer S,Sella A, Chemotherapy with an every-2-week regimen of gemcitabine and paclitaxel in patients with transitional cell carcinoma who have received prior cisplatin-based therapy. Cancer. 2001 Dec 15     [PubMed]
Tewari KS,Sill MW,Long HJ 3rd,Penson RT,Huang H,Ramondetta LM,Landrum LM,Oaknin A,Reid TJ,Leitao MM,Michael HE,Monk BJ, Improved survival with bevacizumab in advanced cervical cancer. The New England journal of medicine. 2014 Feb 20     [PubMed]
Monk BJ,Sill MW,McMeekin DS,Cohn DE,Ramondetta LM,Boardman CH,Benda J,Cella D, Phase III trial of four cisplatin-containing doublet combinations in stage IVB, recurrent, or persistent cervical carcinoma: a Gynecologic Oncology Group study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2009 Oct 1     [PubMed]
Moore DH,Blessing JA,McQuellon RP,Thaler HT,Cella D,Benda J,Miller DS,Olt G,King S,Boggess JF,Rocereto TF, Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: a gynecologic oncology group study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2004 Aug 1     [PubMed]
van Hagen P,Hulshof MC,van Lanschot JJ,Steyerberg EW,van Berge Henegouwen MI,Wijnhoven BP,Richel DJ,Nieuwenhuijzen GA,Hospers GA,Bonenkamp JJ,Cuesta MA,Blaisse RJ,Busch OR,ten Kate FJ,Creemers GJ,Punt CJ,Plukker JT,Verheul HM,Spillenaar Bilgen EJ,van Dekken H,van der Sangen MJ,Rozema T,Biermann K,Beukema JC,Piet AH,van Rij CM,Reinders JG,Tilanus HW,van der Gaast A, Preoperative chemoradiotherapy for esophageal or junctional cancer. The New England journal of medicine. 2012 May 31     [PubMed]
Gibson MK,Li Y,Murphy B,Hussain MH,DeConti RC,Ensley J,Forastiere AA, Randomized phase III evaluation of cisplatin plus fluorouracil versus cisplatin plus paclitaxel in advanced head and neck cancer (E1395): an intergroup trial of the Eastern Cooperative Oncology Group. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2005 May 20     [PubMed]
Pagliaro LC,Williams DL,Daliani D,Williams MB,Osai W,Kincaid M,Wen S,Thall PF,Pettaway CA, Neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy for metastatic penile cancer: a phase II study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2010 Aug 20     [PubMed]
Smit EF,Fokkema E,Biesma B,Groen HJ,Snoek W,Postmus PE, A phase II study of paclitaxel in heavily pretreated patients with small-cell lung cancer. British journal of cancer. 1998     [PubMed]
Yamamoto N,Tsurutani J,Yoshimura N,Asai G,Moriyama A,Nakagawa K,Kudoh S,Takada M,Minato Y,Fukuoka M, Phase II study of weekly paclitaxel for relapsed and refractory small cell lung cancer. Anticancer research. 2006 Jan-Feb     [PubMed]
Penel N,Bui BN,Bay JO,Cupissol D,Ray-Coquard I,Piperno-Neumann S,Kerbrat P,Fournier C,Taieb S,Jimenez M,Isambert N,Peyrade F,Chevreau C,Bompas E,Brain EG,Blay JY, Phase II trial of weekly paclitaxel for unresectable angiosarcoma: the ANGIOTAX Study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2008 Nov 10     [PubMed]
Schlemmer M,Reichardt P,Verweij J,Hartmann JT,Judson I,Thyss A,Hogendoorn PC,Marreaud S,Van Glabbeke M,Blay JY, Paclitaxel in patients with advanced angiosarcomas of soft tissue: a retrospective study of the EORTC soft tissue and bone sarcoma group. European journal of cancer (Oxford, England : 1990). 2008 Nov     [PubMed]
Bokemeyer C,Oechsle K,Honecker F,Mayer F,Hartmann JT,Waller CF,Böhlke I,Kollmannsberger C, Combination chemotherapy with gemcitabine, oxaliplatin, and paclitaxel in patients with cisplatin-refractory or multiply relapsed germ-cell tumors: a study of the German Testicular Cancer Study Group. Annals of oncology : official journal of the European Society for Medical Oncology. 2008 Mar     [PubMed]
Kondagunta GV,Bacik J,Donadio A,Bajorin D,Marion S,Sheinfeld J,Bosl GJ,Motzer RJ, Combination of paclitaxel, ifosfamide, and cisplatin is an effective second-line therapy for patients with relapsed testicular germ cell tumors. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2005 Sep 20     [PubMed]
Einhorn LH,Brames MJ,Juliar B,Williams SD, Phase II study of paclitaxel plus gemcitabine salvage chemotherapy for germ cell tumors after progression following high-dose chemotherapy with tandem transplant. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2007 Feb 10     [PubMed]
Lemma GL,Lee JW,Aisner SC,Langer CJ,Tester WJ,Johnson DH,Loehrer PJ Sr, Phase II study of carboplatin and paclitaxel in advanced thymoma and thymic carcinoma. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2011 May 20     [PubMed]
Briasoulis E,Kalofonos H,Bafaloukos D,Samantas E,Fountzilas G,Xiros N,Skarlos D,Christodoulou C,Kosmidis P,Pavlidis N, Carboplatin plus paclitaxel in unknown primary carcinoma: a phase II Hellenic Cooperative Oncology Group Study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2000 Sep     [PubMed]
Greco FA,Burris HA 3rd,Erland JB,Gray JR,Kalman LA,Schreeder MT,Hainsworth JD, Carcinoma of unknown primary site. Cancer. 2000 Dec 15     [PubMed]
Rose PG,Ali S,Moslemi-Kebria M,Simpkins F, Paclitaxel, Carboplatin, and Bevacizumab in Advanced and Recurrent Endometrial Carcinoma. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. 2017 Mar     [PubMed]
Noronha V,Patil V,Bhosale B,Joshi A,Purandare N,Prabhash K, Metronomic weekly paclitaxel in advanced unresectable esophageal cancer. Indian journal of cancer. 2013 Apr-Jun     [PubMed]
Bozkurt M,Amlashi FG,Blum Murphy M, The role of chemotherapy in unresectable or metastatic adenocarcinoma of the stomach and gastroesophageal junction. Minerva chirurgica. 2017 Aug     [PubMed]
Zheng AW,Jia DD,Xia LM,Jin G,Wu H,Li T, Impact of carboplatin plus paclitaxel combined with endostar against A375 melanoma cells: An in vitro and in vivo analysis. Biomedicine     [PubMed]
Onoda N,Sugino K,Higashiyama T,Kammori M,Toda K,Ito K,Yoshida A,Suganuma N,Nakashima N,Suzuki S,Tsukahara K,Noguchi H,Koizumi M,Nemoto T,Hara H,Miyauchi A,Sugitani I, The Safety and Efficacy of Weekly Paclitaxel Administration for Anaplastic Thyroid Cancer Patients: A Nationwide Prospective Study. Thyroid : official journal of the American Thyroid Association. 2016 Sep     [PubMed]
Manfredi JJ,Horwitz SB, Taxol: an antimitotic agent with a new mechanism of action. Pharmacology     [PubMed]
Trissel LA, Pharmaceutical properties of paclitaxel and their effects on preparation and administration. Pharmacotherapy. 1997 Sep-Oct     [PubMed]
Toiyama Y,Tanaka K,Konishi N,Mohri Y,Tonouchi H,Miki C,Kusunoki M, Administration sequence-dependent antitumor effects of paclitaxel and 5-fluorouracil in the human gastric cancer cell line MKN45. Cancer chemotherapy and pharmacology. 2006 Feb     [PubMed]
Cheng H,An SJ,Zhang XC,Dong S,Zhang YF,Chen ZH,Chen HJ,Guo AL,Lin QX,Wu YL, In vitro sequence-dependent synergism between paclitaxel and gefitinib in human lung cancer cell lines. Cancer chemotherapy and pharmacology. 2011 Mar     [PubMed]
Saad SY,Najjar TA,Alashari M, Cardiotoxicity of doxorubicin/paclitaxel combination in rats: effect of sequence and timing of administration. Journal of biochemical and molecular toxicology. 2004     [PubMed]
Morgan C,Tillett T,Braybrooke J,Ajithkumar T, Management of uncommon chemotherapy-induced emergencies. The Lancet. Oncology. 2011 Aug     [PubMed]
Banerji A,Lax T,Guyer A,Hurwitz S,Camargo CA Jr,Long AA, Management of hypersensitivity reactions to Carboplatin and Paclitaxel in an outpatient oncology infusion center: a 5-year review. The journal of allergy and clinical immunology. In practice. 2014 Jul-Aug     [PubMed]
Brewer JR,Morrison G,Dolan ME,Fleming GF, Chemotherapy-induced peripheral neuropathy: Current status and progress. Gynecologic oncology. 2016 Jan     [PubMed]
Marupudi NI,Han JE,Li KW,Renard VM,Tyler BM,Brem H, Paclitaxel: a review of adverse toxicities and novel delivery strategies. Expert opinion on drug safety. 2007 Sep     [PubMed]
Ding D,Kong WM, [Analysis of relative factors of bone marrow suppression after chemotherapy with carboplatin and paclitaxel on the patients with ovarian cancer]. Zhonghua fu chan ke za zhi. 2011 Mar     [PubMed]
Pérez Fidalgo JA,García Fabregat L,Cervantes A,Margulies A,Vidall C,Roila F, Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Annals of oncology : official journal of the European Society for Medical Oncology. 2012 Oct     [PubMed]
Ener RA,Meglathery SB,Styler M, Extravasation of systemic hemato-oncological therapies. Annals of oncology : official journal of the European Society for Medical Oncology. 2004 Jun     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of PA-Hospital Medicine. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for PA-Hospital Medicine, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in PA-Hospital Medicine, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of PA-Hospital Medicine. When it is time for the PA-Hospital Medicine board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study PA-Hospital Medicine.