Paclitaxel — Drug Monograph

Brand names: Taxol

Drug class: Taxane

Mechanism of Action

Promotes assembly and stabilizes microtubule polymerization. Binds specifically to the β-tubulin subunit of the microtubule, preventing depolymerization and causing mitotic arrest (M-phase arrest). Blocks cells in the G2/M phase of the cell cycle.

FDA Indications

• Ovarian cancer — first-line with cisplatin; second-line monotherapy
• Breast cancer — adjuvant after anthracycline-based therapy; metastatic after combination failure
• NSCLC — first-line with cisplatin
• AIDS-related Kaposi sarcoma — second-line

Common Side Effects

• Peripheral neuropathy (dose-limiting; cumulative sensory neuropathy)
• Myelosuppression (neutropenia nadir day 8–11)
• Alopecia (universal; reversible)
• Arthralgias and myalgias (especially 2–3 days post-infusion)
• Nausea (low-moderate risk)
• Hypersensitivity reactions (despite premedication in ~2–4%)
• Bradycardia (benign during infusion)

Clinical Pearl

The myalgia/arthralgia syndrome ("paclitaxel aches") peaks 2–3 days post-infusion and resolves by day 7. Prophylactic NSAIDs or dexamethasone may help. The weekly 80 mg/m² schedule (vs. q3-week 175 mg/m²) reduces neuropathy significantly while maintaining efficacy in breast cancer — now standard in many adjuvant and metastatic breast cancer settings. Scalp cooling (cold caps) is FDA-cleared for chemotherapy-induced alopecia in solid tumors and is more effective at preserving hair with taxanes…

Related Therapies & Mechanisms

• Carboplatin (Paraplatin) — Breast
• Pembrolizumab (Keytruda) — NSCLC
• Docetaxel (Taxotere) — Taxane · Breast
• Cisplatin (Platinol) — NSCLC