Presentation
We present a patient with metastatic melanoma who had a complete response to second line chemotherapy with paclitaxel and carboplatin. [ncbi.nlm.nih.gov]
Oncology Paclitaxel October 14, 2017 Saladax is Awarded “Best Poster Presentation” for Study on Individualized Dosing of Paclitaxel Saladax Biomedical, Inc., recently presented a study on the value of adjusting paclitaxel doses. [saladax.com]
View Presentation Presented by: Gary Ansel, MD | March 2019 The Zilver PTX RCT had a unique trial design. [cookmedical.com]
Entire Body System
- Intravenous Administration
It is essentially insoluble in water, so for intravenous administration to cancer patients, it is dissolved in an oil base, Cremophor ® Solution, to form the drug Taxol ®. [cathlabdigest.com]
Preparation for Intravenous Administration TAXOL (paclitaxel) Injection must be diluted prior to infusion. [globalrph.com]
Due to the poor aqueous solubility, polyoxyethylated castor oil solvent (Cremaphor) was used to solubilize paclitaxel for intravenous administration ( Cre -paclitaxel; Taxol). [clincancerres.aacrjournals.org]
Myocardial infarction within the previous 6 months or significant cardiac disease resulting in an inability to tolerate the intravenous fluid load as required for the administration of cisplatin. [bmjopen.bmj.com]
- Sepsis
Other clinically relevant adverse events in the combination group were sepsis (3.1% vs 1.8%) and gastrointestinal perforation (1.2% vs 0.3%). Ramucirumab carries a boxed warning for hemorrhage, including fatal bleeding. [ascopost.com]
Exclusion criteria include previous malignancy within 5 years, recent abdominal or pelvic radiation treatment, significant abdominal adhesions or sepsis. [bmjopen.bmj.com]
Sepsis (all grades) was reported more often in the nab-paclitaxel–gemcitabine group than in the gemcitabine group (5% vs. 2%), as was pneumonitis (4% vs. 1%). [nejm.org]
One patient died during the immediate post-transplant period of sepsis and CHF. Four patients responded to vasodilator therapy and/or digoxin with improvement in cardiac function. At present three patients continue to require cardiac medications. [nature.com]
- Asymptomatic
Because the patient was asymptomatic and pancreatic enzymes decreased on day 16, the third paclitaxel dose was given on day 17 and was followed by another increase of these enzymes. [ncbi.nlm.nih.gov]
Two patients had symptomatic congestive heart failure that normalized after trastuzumab was discontinued, and, of 13 patients with significant asymptomatic declines in ejection fraction, 11 resumed treatment with trastuzumab after a brief interruption [cancertherapyadvisor.com]
Two patients with LVEF of less than 50% were asymptomatic. They had an echocardiogram with increased LVEF during exercise and continued to PBPCT. [nature.com]
A total of 13 patients had significant asymptomatic declines in ejection fraction (3.2%; 95% CI, 1.7 to 5.4), as defined by the study, but 11 of these patients were able to resume trastuzumab therapy after a brief interruption. [nejm.org]
Cardiovascular
- Thrombosis
Inflammatory cells were seen infrequently, and there were no cases of aneurysm or thrombosis. [ncbi.nlm.nih.gov]
Everolimus-eluting stents were superior to paclitaxel-eluting stents with regard to several end points, including target-vessel failure, myocardial infarction, and stent thrombosis. Funding and Disclosures Supported by Boston Scientific. [nejm.org]
Insufficient levels of late loss may leave the struts exposed, and could lead to platelet aggregation and thrombosis. Neointimal and endothelial tissue growth are evidence of healing, as is demonstrated by a low but positive level of late loss. [cathlabdigest.com]
Preliminary experiments that applied paclitaxel by use of a nonbiodegradable (ethylene vinyl acetate) polymeric stent coating were marked by an intense inflammatory response, severe luminal narrowing, thrombosis, and death. [doi.org]
Eyes
- Scintillating Scotoma
Ophthalmic adverse effects include decreased vision, scintillating scotomas, and abnormal visual evoked potentials. 4 Cystoid macular edema most often develops in association with inflammation or after cataract extraction. [jamanetwork.com]
It is a chemotherapeutic agent that inhibits the formation of intracellular microtubules, and whose ophthalmological side effects often include low visual acuity, scintillating scotomas and changes in evoked visual potential. [scielo.br]
Musculoskeletal
- Arthralgia
Adverse Reactions: Bone marrow suppression (eg, neutropenia, leukopenia, thrombocytopenia, anemia), inj site reactions, infections, hypotension, bradycardia, hypersensitivity reactions (if severe, do not rechallenge), peripheral neuropathy, myalgia, arthralgia [empr.com]
Arthralgia/Myalgia : There was no consistent relationship between dose or schedule of TAXOL and the frequency or severity of arthralgia/myalgia. Sixty percent of all patients treated experienced arthralgia/myalgia; 8% experienced severe symptoms. [rxlist.com]
Myalgias, arthralgias, and peripheral neuropathy were mild. No hypersensitivity reactions and no cardiac toxicity were observed. Conclusion: Taxol is highly active as initial chemotherapy for metastatic breast cancer. [pubmed.ncbi.nlm.nih.gov]
[…] than 1 patient in 10) are neutropenia (low levels of neutrophils, a type of white blood cells), gastrointestinal disorders (disorders of the digestive system), peripheral neuropathy (nerve damage including damage to the nerves in the hand and feet), arthralgia [ema.europa.eu]
Read more about skin rash Arthralgia and myalgia Generalised joint pain or and/or stiffness and muscle aches, often worse upon waking or after long periods of inactivity. Can improve with movement. [eviq.org.au]
Skin
- Alopecia
[…] suppression (eg, neutropenia, leukopenia, thrombocytopenia, anemia), inj site reactions, infections, hypotension, bradycardia, hypersensitivity reactions (if severe, do not rechallenge), peripheral neuropathy, myalgia, arthralgia, GI upset, mucositis, alopecia [empr.com]
Slight alopecia is also common. Chemical Properties White Powder Uses glucocorticoid, antiinflammatory Uses An antineoplastic. Used in the study of structure and function of microtubles into tubulin. [chemicalbook.com]
Additional side effects, including fever, infection, nausea, vomiting, increase or decrease in blood pressure, diarrhea, weight loss, pain, and hair loss ( alopecia ) may occur. [encyclopedia.com]
Adverse effects included generalized alopecia in all patients. Myalgias, arthralgias, and peripheral neuropathy were mild. No hypersensitivity reactions and no cardiac toxicity were observed. [pubmed.ncbi.nlm.nih.gov]
[…] grade 3 or more) Rash 6 (0) 35 (14) 9 (0) ALT increased 1 (0) 2 (0) 12 (9) Fatigue 19 (1) 24 (4) 18 (3) Dyspnoea 8 (1) 10 (1) 8 (2) Abdominal pain 7 (0) 11 (1) 14 (2) Diarrhoea 17 (0) 24 (2) 20 (1) Nausea 11 (0) 12 (0) 16 (1) Anaemia 3 (0) 6 (2) 8 (0) Alopecia [academic.oup.com]
Face, Head & Neck
- Epistaxis
The most common adverse events of any grade in the ramucirumab/paclitaxel group were fatigue/asthenia (57% vs 44% in the paclitaxel group), neutropenia (54% vs 31%), diarrhea (32% vs 23%), epistaxis (31% vs 7%), peripheral edema (25% vs 14%), and hypertension [ascopost.com]
11 (1) 14 (2) Diarrhoea 17 (0) 24 (2) 20 (1) Nausea 11 (0) 12 (0) 16 (1) Anaemia 3 (0) 6 (2) 8 (0) Alopecia 17 (1) 13 (0) 13 (0) Anorexia 6 (0) 13 (0) 11 (0) Constipation 11 (0) 13 (0) 2 (0) Dysgeusia 3 (0) 4 (0) 12 (0) Dyspepsia 7 (0) 4 (0) 4 (0) Epistaxis [academic.oup.com]
[…] neuropathy, arthralgia) more common in patients ≥65 years of age. 354 Albumin-bound paclitaxel and gemcitabine for pancreatic cancer: No overall differences in efficacy relative to younger adults, but toxicity (diarrhea, decreased appetite, dehydration, epistaxis [web.archive.org]
Neurologic
- Peripheral Neuropathy
There were no significant differences in measures of neuropathy or pain between treated and untreated hands or feet. CONCLUSIONS: Strategies to prevent painful peripheral neuropathy are urgently needed. [ncbi.nlm.nih.gov]
Segal said having discovered the mechanism that causes peripheral neuropathy in patients treated with taxane chemotherapy might be valuable in other ways. [ascopost.com]
Adverse Reactions: Bone marrow suppression (eg, neutropenia, leukopenia, thrombocytopenia, anemia), inj site reactions, infections, hypotension, bradycardia, hypersensitivity reactions (if severe, do not rechallenge), peripheral neuropathy, myalgia, arthralgia [empr.com]
Workup
Serum
- Neutrophil Count Decreased
Neutrophil count decrease was also more frequent in nab-paclitaxel group (41.8%) compared with the paclitaxel group (36.4%). [am.asco.org]
Treatment
Treatment was well tolerated with no significant toxicity or need for dose reduction. [ncbi.nlm.nih.gov]
Prognosis
Metastatic melanoma is an aggressive cancer with poor prognosis and 10 year survival less than 10%. We present a patient with metastatic melanoma who had a complete response to second line chemotherapy with paclitaxel and carboplatin. [ncbi.nlm.nih.gov]
Etiology
Although our patient's history was significant for previous radiation therapy, the lack of accompanying funduscopic findings and absence of leakage at angiography makes radiation therapy an unlikely etiologic factor. [jamanetwork.com]
Using the CEC narratives and the etiology of deaths provided, the causes of death were categorized by organ system classification. Statistical analyses All descriptive summaries were based on nonmissing assessments. [onlinejacc.org]
Epidemiology
PATIENTS AND METHODS: This study aimed to describe the outcome following first-line paclitaxel with or without bevacizumab in the French Epidemiological Strategy and Medical Economics (ESME) database of MBC patients, established in 2014 by Unicancer. [unicancer.fr]
Electronic address: [email protected]. 6 Department of Hygiene, Epidemiology and Preventive Medicine, Third Faculty of Medicine, Charles University, Ruská 87, 110 00 Prague, Czech Republic. [ncbi.nlm.nih.gov]
Meta‐Regression Analysis In line with Bradford Hill's criteria 61 for establishing epidemiological evidence for causation, we explored presence of a biological gradient, that is, whether greater exposure leads to greater incidence of the effect. [ahajournals.org]
Harnett & Anna de Fazio Chris O’Brien Lifehouse, Sydney, Australia Philip Beale & Michelle Harrison Centre for Cancer Genetic Epidemiology, Department of Oncology, Cambridge University, Cambridge, UK Craig Luccarini & Don Conroy Sydney West Translational [nature.com]
Mortality rates across the individual trials of DCBs are well within the ranges reported in other adjudicated nondrug vascular device trials and also reported in epidemiological studies of patients with PAD. [onlinejacc.org]
Pathophysiology
Its pathophysiology remains poorly understood. Here, we report on a 69-year-old woman who developed cystoid macular edema associated with the albumin-bound formulation of paclitaxel after several months of therapy for breast cancer. [ncbi.nlm.nih.gov]
There has been 1 reported case of CME without leakage on fluorescein angiograms associated with docetaxel therapy. 3 The pathophysiology of angiographically negative CME is unclear. [jamanetwork.com]
Toxicity to Müller cells is the theory for the pathophysiological mechanism, with subsequent accumulation of intracellular fluid and subclinical extracellular extravasation ( 3, 5, 6 ). [scielo.br]
Prevention
It is currently unclear whether protein kinase C inhibition can prevent chemotherapy-induced neuropathy. [ncbi.nlm.nih.gov]
Adding the Bclw protein to the nerve axons before exposing them to paclitaxel prevented the nerves from dying off. [ascopost.com]