Taxol (paclitaxel) is an intravenous (IV) chemotherapy drug used to treat cancer. It’s one of the most effective and commonly used drugs for treating breast cancer at all stages.

This medication is also used to prevent recurrence after tumors are surgically removed. It's also used to treat some cases of other cancers. 

Taxol can cause side effects such as nerve damage, anemia, fatigue, body aches, and digestive problems. You'll likely need to have frequent bloodwork while you take it.

This article explains how Taxol works and looks at various dosages, risks, side effects, and how to prevent them.

Types of Cancer Taxol Treats

The chemotherapy class of taxanes includes the drugs Taxol and Taxotere (docetaxel). Taxol is a versatile drug used to treat breast cancer. It can be used in both early-stage breast cancer and metastatic breast cancer (cancer that has spread to other organs).

Taxol is also used to treat several other types of cancer, including ovarian cancer, lung cancer, and Kaposi’s sarcoma, a rare type of skin cancer that disproportionately affects people with HIV and AIDS.

Typically, oncologists prescribe Taxol as part of combination treatments along with other chemotherapy drugs such as:

• Adriamycin (doxorubicin)
• Cytoxan (cyclophosphamide)
• 5-FU (5-fluorouracil)
• Xeloda (capecitabine)
• Paraplatin (carboplatin)

While there are standard chemotherapy combinations, your healthcare team will customize your treatment plan for you depending on the characteristics of your cancer and your overall health.

Doctors also use Taxol as part of neoadjuvant chemotherapy.

How Taxol Works

All cells, including tumor cells, divide and multiply by a process called mitosis.

Taxol inhibits mitosis in rapidly dividing cancer cells, which keeps tumors from growing. It does this by getting inside of your cells, attaching to scaffold-like structures called microtubules, and interfering with their function.

While the whole point is to stop cell division, Taxol can affect any of the rapidly dividing cells of your body, not just cancer cells. This is what causes many of the side effects of chemotherapy treatments. 

Your oncologist will monitor you regularly while you’re taking Taxol to see how you’re responding to the therapy. You should expect intermittent tests to check on the tumor size and location. Typically, that means routine blood work including a complete blood count (CBC) and a comprehensive metabolic panel (CMP) to monitor your kidney and liver function.

Taxol Preparation and Dosing

Taxol is a clear, colorless fluid that’s mixed with Cremophor EL (polyoxyethylated castor oil) and given by intravenous (in a vein) infusion. Infusions are generally done in hospitals or clinics.

Your Taxol dose depends on many factors, including:

• Your height
• Your weight
• Your general health
• The type of cancer you have

Taxol can only be given by a healthcare provider. That's because if it's not administered properly, it can cause tissue damage, typically at the infusion site.

You may be given medications like Benadryl (diphenhydramine) before your infusion to reduce the risk of an allergic reaction.

How Long Does Taxol Chemo Take?

You'll likely go through several dosing cycles of Taxol. This may occur:

Read more  Paclitaxel’s Mechanistic and Clinical Effects on Breast Cancer

• Once every two or three weeks (1 to 3 hours per session)
• Once a week (1 to 3 hours per session)
• Slowly over 24 hours

Taking time off between cycles allows your body to recover. Your healthcare team will monitor your blood cell counts to see if they've returned to normal.

The number of cycles you will have depends on many factors, including what type of cancer you have and how well it responds to treatment. For primary breast cancer, it's typical to have between three and six cycles.

Side Effects of Taxol

Most people tolerate Taxol well, especially in low doses. However, it can cause certain side effects, such as:

• Peripheral neuropathy (pain from nerve damage)
• Anemia (low red blood cell count)
• Neutropenia (low white blood cell count)
• Bone and muscle aches
• Hair loss
• Fatigue
• Nausea
• Vomiting
• Mild diarrhea
• Amenorrhea (absence of menstruation)

Let your healthcare team know about any side effects you have. Some of them may be manageable with medications.

Preventing Taxol Side Effects

Side effects are always a big concern when chemotherapy is involved. The good news is that you can take steps to prevent some of them.

Chemotherapy makes bone marrow less able to produce new blood cells. A low white blood cell count makes your immune system less effective and puts you at a higher risk for infections.

Neupogen (filgrastim) and Neulasta (pegfilgrastim) are two injectable medications given to boost white blood cell production and to help prevent infections. 

• Neupogen is given daily until the white blood cell counts improve.
• Neulasta is given in a single dose that remains in effect for an extended time.

Which of these drugs you're given can depend on factors such as your health and your insurance coverage.

The timing of these immune-stimulating medications is important. Ideally, you want to start taking them before your white blood cells hit their lowest point (called the nadir). The first dose is usually given at least 24 hours after your chemotherapy infusion is complete.

Most side effects of chemotherapy go away rapidly after your treatment is concluded. However, some long-term side effects of chemotherapy may persist. In particular, peripheral neuropathy may sometimes be permanent, and fatigue may sometimes take years to improve fully.

When to Call Your Healthcare Provider

You should call your healthcare provider immediately or get emergency medical care if you have signs of infection during treatment with Taxol. These include:

• Fever above 100.4 degrees Fahrenheit
• Chills

An allergic reaction to Taxol is also a medical emergency. Symptoms generally appear within 24 hours of injection. Call 9-1-1 or go to an emergency room for:

• Shortness of breath
• Wheezing
• Difficulty breathing
• Swelling in the throat or facial features
• Hives

Risks and Contraindications

As with other chemotherapy drugs, Taxol does come with some risks. This drug isn't right for everyone.

Drug Interactions

To avoid risky interactions, your medical team may advise you not to drink alcohol or take medications that contain alcohol. Examples of these are:

• Pepto-Bismol/Kaopectate (bismuth subsalicylate)
• Pylera capsules (bismuth subcitrate potassium)
• Flagyl (metronidazole)
• Achromycin/Sumycin (tetracycline)

You may also be told to avoid certain medications that could interact badly with Taxol. Some affect how the drugs work while others may increase your risk of heavy bleeding. These include:

• Restasis/Sandimmune/Gengraf (cyclosporine)
• Antabuse (disulfiram)
• Lopid (gemfibrozil)
• Katerzia/Norvasc (amlodipine)
• Zydelig (idelalisib)
• Lysodren (mitotane)
• Cuprimine/Depen (penicillamine)

Non-steroidal anti-inflammatory drugs (NSAIDs) can also increase your bleeding risk when combined with Taxol. Common NSAIDs include:

• Celebrex (celecoxib)
• Mobic/Vivlodex (meloxicam)
• Advil/Motrin (ibuprofen)
• Aleve (naproxen)
• Pennsaid/Voltaren (diclofenac)
• Diflunisal
• Lodine (etodolac)
• Nalfon (fenoprofen)
• Ketoprofen
• Relafen (nabumetone)
• Feldene (piroxicam)

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Also, you shouldn't drink grapefruit juice while on Taxol (or many other medications) because it can interfere with the amount of the drug your body absorbs.

Pregnancy and Lactation

If taken during pregnancy, Taxol can potentially harm a developing fetus. Therefore, you should not receive Taxol while pregnant. Due to Taxol’s risk during pregnancy, your provider will likely recommend birth control while you are taking Taxol if you are a sexually active female of child-bearing age.

In addition, Taxol can pass through to breast milk. It is generally recommended that you avoid breastfeeding while receiving Taxol and for several weeks after you complete your treatment.

Vaccines

Vaccines may not be as effective when you are receiving chemotherapy. Due to your weakened immune system, your body may not produce enough of an immune response to get the benefit from the vaccine. Most of the time, vaccines are delayed and given after cancer treatment is complete.

Since chemotherapy drugs compromise the immune system, live vaccines are generally not recommended while undergoing Taxol treatment. A weakened immune system during treatment may make you more susceptible to getting an infection from the vaccine.

The flu vaccine FluMist is a nasal spray with a weakened form of the influenza virus. This is one of the live vaccines that should be avoided in people with compromised immune systems—including those receiving Taxol.

However, most vaccines (such as flu shots or COVID vaccines) are safe during chemotherapy. Inactivated vaccines use pre-killed pathogens (germs), and many vaccines use virus-like substances to stimulate the immune system.

Infections

You will be susceptible to infections while taking Taxol, which can often become very serious and even life-threatening. Chemotherapy reduces the production of white blood cells called neutrophils and leaves your immune system in a weakened state. A low neutrophil count is called neutropenia. A risk of infection may be present even if you receive Neulasta or Neupogen.

Due to this increased risk, call your healthcare provider immediately if you develop a fever, chills, pain, or notice redness or swelling at the infusion site. Neutropenic fevers are considered a medical emergency.

Allergic Reaction

Some people may have an allergic reaction to Taxol or Cremophor EL, and therefore should avoid this drug. Your healthcare team will monitor you closely while you receive Taxol and may give treatment if you develop a reaction.

Summary

Taxol is a common chemotherapy medication for breast cancer, ovarian cancer, lung cancer, and Kaposi's sarcoma. Common Taxol side effects are vomiting, hair loss, fatigue, and nerve damage. Some of these side effects can be prevented or lessened through supplements and medications. 

Chemotherapy drugs are powerful, so your provider will discuss the risks and benefits with you prior to giving you the drug. You shouldn't take Taxol if you're pregnant, breastfeeding, or allergic to it. During treatment, you're more susceptible to serious infections.

A Word From Verywell

As with any form of chemotherapy, Taxol can take a toll on your energy. Try to eat healthily, exercise when possible, and get adequate rest during treatment. In addition, learn to ask for and accept help. 

Finally, keep in mind that one of the most common complaints from people who have a loved one coping with cancer is a sense of helplessness. Therefore, allowing your loved one to lend a hand may help both of you.

— Update: 15-03-2023 — cohaitungchi.com found an additional article Paclitaxel’s Mechanistic and Clinical Effects on Breast Cancer from the website www.ncbi.nlm.nih.gov for the keyword taxol breast cancer.

2. Breast Cancer from the View of Prevalence and Intrinsic Subtypes

BC is the most frequent type of cancer among females, as it constitutes 24% of all female malignancies. BC affects nearly two million females worldwide and is responsible for more than 620,000 deaths annually [2]. Factors such as age, frequency of pregnancies, genetic predisposition, ethnic background, and intake of oral contraceptives all contribute to the increased risk of BC in women [17]. Despite the massive progress in the field of screening tools and programs, the incidence and mortality rates are still rising [18].

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Importantly, breast malignancy is a heterogeneous disease characterized by enormous variability in phenotypes and genotypes, meaning that no two patients experience the same clinical features [19]. These differences make the process of targeting BC more complicated. BC can be categorized into 3 main types and 5 subtypes characterized by alterations in the expression of specific genes and the presence or absence of surface receptors resulting in the difference in prognosis and therapy approaches for patients [20]. According to signatures, including the immunohistochemical analysis of receptors, the expression profile of human epidermal growth factor receptor 2 (HER2), and the KI67 proliferative index, these subtypes are classified into HER2 positive (HER2+), luminal types, and triple-negative BC (TNBC) [21].

HER2+ BC is the result of the over-expression of the HER2 (ERBB2) gene that encodes a transmembrane glycoprotein receptor p185HER2 [22]. Amplification of HER2 was detected in approximately 15–0% of invasive BC cases. Moreover, a higher frequency of the mutation in HER2 leading to increased expression of the protein was also identified in gastric, esophageal, and other types of cancer [23].

The prevalence of TNBC as the most aggressive form is 10–20%, with higher abundance in the cohort of young women. This molecular subtype is associated with an advanced stage, higher grade of the tumor, overall worse survival rates of patients associated with cancer recurrence, and development of metastasis [24]. Immunohistochemically, TNBC is characterized by the lack of three receptors: estrogen receptor (ER), progesterone receptor (PR), and HER2. Due to the lack of receptors to target, this type of BC is resistant to available treatments [25,26]. Furthermore, TNBC can be classified into claudin-low, basal-like, and molecular apocrine types as a consequence of alterations in gene signatures and histological features (as referred to in Table 1) [27]. Furthermore, hereditary mutations in tumor suppressor genes BRCA1/2 were detected in 15% of patients with diagnosed TNBC [28]. Additionally, recent evidence suggested an association between genes including BARD1, PALB2, and RAD51D and high risk for TNBC [29].

Luminal BC is characterized by the definite presence of ER and the possibility of the presence of PR. Luminal BC can be classified into luminal A and B according to the HER2 profile and the presence of proliferation genes such as CCNB1, MKI67, and MYBL2, which are generally expressed in luminal B subtype. Moreover, luminal B is characterized by a higher expression of genes connected with growth receptor signaling [30,31,32]. Based on a clinical prediction and patients’ prognosis, luminal A represents molecular subtypes with a better prognosis, low relapse, and higher overall survival rate when compared to luminal B [33].

Importantly, human cancer-derived cell lines, which are specific for each molecular subtype, represent powerful tools to study biological processes in cancer research because they carry specific genetic alterations of tumors they were derived from [34]. Table 1 summarizes BC subtypes associated with specific immunohistochemical signatures and the corresponding cell line used in in vitro experiments.