Key points
- Paclitaxel (Taxol) is an injected chemotherapy drug that comes from the yew tree and stops cancer cells from dividing [1].
- It is used in ovarian, breast and lung cancer, and in standard combinations for cervical, oesophageal and stomach cancer [1, 2, 3, 4].
- Before every infusion you are given medicines to prevent an allergic reaction, because a severe reaction has happened in a few people out of every 100 [1].
- The most common side effects: hair loss, numbness and tingling in the hands and feet, muscle and joint pain, and low white blood cells [1].
- White blood cells reach their lowest point about 10 days after the infusion; if they are too low before an infusion, it is postponed [1].
- It interacts with some medicines; talk to your doctor before starting any new medicine [1].
What is this drug and how does it work?
For physicians
Paclitaxel is a semi-synthetic anticancer drug obtained from species of the yew tree (Taxus) [1]. It is an "antimicrotubule agent": it promotes the assembly of microtubules from tubulin units and stabilises them by preventing their breakdown. The result is a loss of the dynamic reorganisation of the microtubule network that is essential for cell division (mitosis) and vital cell functions [1].
Paclitaxel does not dissolve in water, and its usual formulation is made with polyoxyl 35 castor oil and alcohol; patients who have had a severe allergic reaction to drugs containing this solvent should not receive it [1].
Nab-paclitaxel (Abraxane) is a different formulation of the same substance, made as albumin-bound particles; its dosing and administration differ from conventional paclitaxel and the two must not be substituted for each other [5].
Which cancers is it used for?
Your doctor may prescribe this drug for:
- Ovarian cancer [1, 7]
- Breast cancer [1, 9]
- Non-small cell lung cancer [1]
- Cervical cancer [2]
- Cancer of the oesophagus and the junction between the oesophagus and stomach [3]
- Stomach cancer (second line) [4]
- AIDS-related Kaposi sarcoma [1]
- Pancreatic cancer (nab-paclitaxel) [5]
Whether it suits you depends on the type and stage of your cancer and your test results. Details of each use are in the section for doctors.
For physicians
| Cancer | Treatment setting |
|---|---|
| Ovarian cancer | First line with cisplatin and later-line treatment of advanced disease (FDA label indication) [1]; today first line is usually with carboplatin [7] |
| Breast cancer | Adjuvant treatment of node-positive disease after doxorubicin-containing chemotherapy; metastatic disease after failure of combination chemotherapy (FDA label indications) [1]; neoadjuvant in triple-negative cancer [9] |
| Non-small cell lung cancer | First line with cisplatin in patients who are not candidates for curative surgery or radiotherapy (FDA label indication) [1] |
| Cervical cancer | Metastatic, persistent or recurrent disease; cisplatin + paclitaxel with bevacizumab [2] |
| Oesophageal and gastro-oesophageal junction cancer | Chemoradiotherapy before surgery (CROSS regimen) [3] |
| Stomach cancer (second line) | Weekly paclitaxel with ramucirumab [4] |
| AIDS-related Kaposi sarcoma | Second-line treatment (FDA label indication) [1] |
| Pancreatic cancer (nab-paclitaxel) | Metastatic disease, first line with gemcitabine — with the albumin-bound formulation (Abraxane), not conventional paclitaxel [5] |
| Cancer | Key evidence |
|---|---|
| Ovarian cancer | In a GOG trial of 410 women, cisplatin + paclitaxel increased median overall survival from 24 to 38 months compared with cisplatin + cyclophosphamide [1, 6]. In GOG-158, carboplatin + paclitaxel was less toxic than and non-inferior to cisplatin + paclitaxel [7] |
| Breast cancer | In a trial of 3121 women with node-positive disease, adding 4 cycles of paclitaxel after doxorubicin–cyclophosphamide reduced the risk of recurrence by 17% and the risk of death by 18% [1, 8]. In KEYNOTE-522, adding pembrolizumab to neoadjuvant paclitaxel–carboplatin increased the pathological complete response rate from 51.2% to 64.8% [9] |
| Non-small cell lung cancer | In an ECOG trial of 1207 patients, cisplatin + paclitaxel and carboplatin + paclitaxel gave results similar to other platinum doublets [1, 10] |
| Cervical cancer | In GOG 240, adding bevacizumab to chemotherapy (cisplatin or topotecan with paclitaxel) increased median overall survival from 13.3 to 17.0 months; topotecan–paclitaxel was not superior to cisplatin–paclitaxel [2] |
| Oesophageal and gastro-oesophageal junction cancer | In CROSS, weekly paclitaxel and carboplatin for 5 weeks with radiotherapy followed by surgery increased median overall survival from 24.0 to 49.4 months [3] |
| Stomach cancer (second line) | In DESTINY-Gastric04 (HER2-positive patients), ramucirumab + paclitaxel was the control arm and trastuzumab deruxtecan gave better overall survival (median 14.7 vs 11.4 months) [4] |
| AIDS-related Kaposi sarcoma | FDA label indication [1] |
| Pancreatic cancer (nab-paclitaxel) | In MPACT, with 861 patients, nab-paclitaxel + gemcitabine increased median overall survival from 6.7 to 8.5 months (HR 0.72) [5, 11] |
How it is given and dose
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Treatment regimens and doses: index10 regimens
Paclitaxel is given as an intravenous infusion at the chemotherapy centre; in the label regimens the infusion usually takes 3 hours (24 hours in some regimens) and is repeated every 3 weeks [1]. In some common regimens the drug is given at a lower dose weekly, for example in the CROSS regimen [3].
To prevent a severe allergic reaction, all patients receive medicines before the infusion; the label lists oral dexamethasone about 12 and 6 hours before the infusion, and an intravenous antihistamine and H2 blocker 30 to 60 minutes before it [1]. If you have been given dexamethasone tablets to take at home, take them exactly on time, and if you forget, tell the nurse before the infusion starts. Vital signs are monitored, especially during the first hour of the infusion [1].
A blood test is done before each cycle, and if neutrophils or platelets are too low, the infusion is postponed [1]. Never skip or move a treatment appointment on your own.
Premedication (all patients): dexamethasone 20 mg orally about 12 and 6 hours before the infusion; diphenhydramine (or equivalent) 50 mg IV and cimetidine 300 mg or ranitidine 50 mg IV, 30 to 60 minutes before the infusion [1].
Before starting and before each cycle: in solid tumours, do not give with baseline neutrophils below 1500/µL (below 1000 in Kaposi sarcoma); do not repeat the next cycle until neutrophils are above 1500 and platelets above 100,000. The neutrophil nadir is around day 11 [1].
Hypersensitivity and administration: mild symptoms (flushing, skin reaction, dyspnoea, mild hypotension or tachycardia) do not require stopping; hypotension needing treatment, dyspnoea needing bronchodilators, angioedema or generalised urticaria: stop immediately and do not rechallenge. Dilute to 0.3 to 1.2 mg/mL; glass, polypropylene or polyolefin containers and non-PVC sets; in-line filter of 0.22 microns or less. When combined with cisplatin, give paclitaxel before cisplatin; the reverse sequence was associated with more severe myelosuppression and about 33% lower clearance [1].
Dose adjustment: severe neutropenia (below 500 for 7 days or more) or severe peripheral neuropathy: reduce the dose by 20% for all subsequent cycles [1].
Liver (first-cycle dose): 3-hour infusion with transaminases below 10 × ULN: bilirubin up to 1.25 × ULN → 175; 1.26 to 2 × → 135; 2.01 to 5 × → 90 mg/m²; transaminases 10 × or more or bilirubin above 5 × → not recommended. 24-hour infusion: transaminases below 2 × and bilirubin up to 1.5 mg/dL → 135; transaminases 2 to less than 10 × and bilirubin up to 1.5 → 100; bilirubin 1.6 to 7.5 → 50; transaminases 10 × or more or bilirubin above 7.5 → not recommended [1]. The label has no renal dose adjustment.
Monitoring: frequent CBC; vital signs during the infusion, especially in the first hour; continuous cardiac monitoring only in severe conduction abnormalities; with doxorubicin in metastatic breast cancer, monitor cardiac function; peripheral neuropathy and the injection site (extravasation) [1].
For physicians
Standard doses (FDA label)
Ovary, first line (label)
Previously untreated advanced ovarian cancerCycle length: Every 3 weeks
Previously untreated advanced ovarian cancer
Before prescribing: Prescribing notes| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Option A | |||
| Paclitaxel | 175 mg/m² | IV infusion over 3 hours | Day 1, before cisplatin |
| Cisplatin | 75 mg/m² | IV | Day 1 |
| Option B | |||
| Paclitaxel | 135 mg/m² | IV infusion over 24 hours | Day 1, before cisplatin |
| Cisplatin | 75 mg/m² | IV | Day 1 |
The choice between the two regimens is based on their different toxicities [1]. In practice, carboplatin now usually replaces cisplatin (GOG-158) [7].
Evidence: GOG-158 (2003)
Ovary, previously treated (label)
Ovarian cancer after previous chemotherapyCycle length: Every 3 weeks
Ovarian cancer after previous chemotherapy
Before prescribing: Prescribing notes| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Paclitaxel | 135 or 175 mg/m² | IV infusion over 3 hours | Day 1 |
[1]
Breast, adjuvant, node-positive (label)
After doxorubicin-containing combination chemotherapy (in the trial: 4 cycles of AC)Cycle length: Every 3 weeks
After doxorubicin-containing combination chemotherapy (in the trial: 4 cycles of AC)
Before prescribing: Prescribing notes| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Paclitaxel | 175 mg/m² | IV infusion over 3 hours | Day 1 |
[1]
Breast, metastatic (label)
After failure of combination chemotherapy for metastatic disease or relapse within 6 months of adjuvant treatmentCycle length: Every 3 weeks
After failure of combination chemotherapy for metastatic disease or relapse within 6 months of adjuvant treatment
Before prescribing: Prescribing notes| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Paclitaxel | 175 mg/m² | IV infusion over 3 hours | Day 1 |
[1]
Non-small cell lung (label)
First line in patients who are not candidates for curative surgery or radiotherapyCycle length: Every 3 weeks
First line in patients who are not candidates for curative surgery or radiotherapy
Before prescribing: Prescribing notes| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Paclitaxel | 135 mg/m² | IV infusion over 24 hours | Day 1 |
| Cisplatin | 75 mg/m² | IV, after paclitaxel | Day 1 |
[1]
AIDS-related Kaposi sarcoma (label)
Second lineCycle length: Every 3 or 2 weeks
Second line
Before prescribing: Prescribing notes| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Option A | |||
| Paclitaxel | 135 mg/m² | IV infusion over 3 hours | Every 3 weeks |
| Option B | |||
| Paclitaxel | 100 mg/m² | IV infusion over 3 hours | Every 2 weeks |
The 2-weekly regimen is less toxic. In advanced HIV: dexamethasone premedication 10 mg (instead of 20), start or repeat only with neutrophils of 1000 or more, 20% dose reduction after severe neutropenia, and G-CSF if needed [1].
Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.
Other regimens: key trials and nab-paclitaxel
CROSS (chemoradiotherapy before surgery)
Resectable oesophageal or gastro-oesophageal junction cancerCycle length: Weekly
Resectable oesophageal or gastro-oesophageal junction cancer
Before prescribing: Prescribing notes| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Paclitaxel | 50 mg/m² | IV | Weekly |
| Carboplatin | AUC 2 | IV | Weekly |
| Radiotherapy | 41.4 Gy in 23 fractions | — | 5 days a week |
The CROSS trial regimen; not in the FDA label [3].
Evidence: CROSS (2012)
GOG 240 (cervix)
Metastatic, persistent or recurrent cervical cancerCycle length: Every 21 days
Metastatic, persistent or recurrent cervical cancer
Before prescribing: Prescribing notes| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Paclitaxel | 135 or 175 mg/m² | IV | Day 1 |
| Cisplatin | 50 mg/m² | IV | Day 1 |
| Bevacizumab | 15 mg/kg | IV | Day 1 |
The GOG 240 trial regimen [2].
Evidence: GOG 240 (2014)
KEYNOTE-522 (triple-negative breast, before and after surgery)
High-risk early triple-negative breast cancerCycle length: 21-day cycles
High-risk early triple-negative breast cancer
Before prescribing: Prescribing notes| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Cycles 1 to 4 | |||
| Pembrolizumab | 200 mg | IV | Day 1 every 3 weeks |
| Paclitaxel | 80 mg/m² | IV | Days 1, 8 and 15 |
| Carboplatin | AUC 5 every 3 weeks or AUC 1.5 weekly | IV | Day 1 (or days 1, 8 and 15) |
| Cycles 5 to 8 | |||
| Pembrolizumab + doxorubicin (or epirubicin) + cyclophosphamide | 200 mg + 60 (or 90) + 600 mg/m² | IV | Day 1 every 3 weeks |
| After surgery | |||
| Pembrolizumab | 200 mg | IV | Every 3 weeks |
Evidence: KEYNOTE-522 (2024), KEYNOTE-522 (2020)
Nab-paclitaxel (Abraxane) — a different formulation
Metastatic pancreatic cancer, first line; non-small cell lung cancer, first line; metastatic breast cancer after failure of chemotherapyCycle length: As per row
Metastatic pancreatic cancer, first line; non-small cell lung cancer, first line; metastatic breast cancer after failure of chemotherapy
Before prescribing: Prescribing notes| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Pancreas | |||
| Nab-paclitaxel, then gemcitabine | 125 mg/m² + 1000 mg/m² | IV, nab-paclitaxel over 30 to 40 minutes | Days 1, 8 and 15 every 28 days |
| Lung | |||
| Nab-paclitaxel + carboplatin | 100 mg/m² + AUC 6 | IV, nab-paclitaxel over 30 minutes | Nab-paclitaxel days 1, 8 and 15; carboplatin day 1; every 21 days |
| Breast | |||
| Nab-paclitaxel | 260 mg/m² | IV over 30 minutes | Every 3 weeks |
Do not substitute for conventional paclitaxel or vice versa; premedication is not routinely needed (only with a history of hypersensitivity). Dose reductions in pancreas: 100 then 75 mg/m² (gemcitabine 800 then 600); lung: 75 then 50 (carboplatin AUC 4.5 then 3); breast: 220 then 180. Moderate or severe hepatic impairment: start at 200 (breast) or 80 (lung); not recommended in pancreas [5].
Before prescribing, check each dose against the drug label, laboratory tests and the patient’s condition.
Side effects
The most common side effects:
- Hair loss in most patients [1].
- Low white blood cells and anaemia; a blood test is needed before every infusion [1].
- Numbness and tingling in the hands and feet, which gets worse with more infusions and usually improves a few months after treatment ends [1].
- Muscle and joint pain 2 to 3 days after the infusion, which settles within a few days [1].
- Nausea, diarrhoea, mouth sores, flushing and a mild rash [1].
For physicians
The figures below are from the FDA label and are based on a pooled analysis of 812 patients with ovarian or breast cancer who received paclitaxel as a single agent with anti-allergy premedication [1]. In combination with other drugs, the frequency of some side effects differs.
| Side effect | Frequency |
|---|---|
| Hair loss | 87% [1] |
| Low neutrophils | Below 2000: 90%; below 500: 52% [1] |
| Anaemia | Haemoglobin below 11: 78%; below 8: 16% [1] |
| Peripheral neuropathy | 60% (severe 3%); increases with cumulative dose, and sensory symptoms usually improve within a few months of stopping the drug [1] |
| Muscle and joint pain | 60% (severe 8%); usually starts 2 to 3 days after the infusion and resolves within a few days [1] |
| Nausea and vomiting, diarrhoea, mouth inflammation | 52%, 38% and 31%; mostly mild to moderate [1] |
| Allergic reaction | All cases 41% (severe 2%); the most common mild reactions: flushing 28% and skin rash 12% [1] |
| Infection and bleeding | Infection 30%; bleeding (mostly local) 14% [1] |
| Changes in vital signs during the infusion | Hypotension 12% and slow heart rate 3% in the first 3 hours of the infusion [1] |
| Oedema, injection-site reaction, nail changes | Oedema 21%, injection-site reaction 13%, nail discolouration 2% [1] |
Serious side effects
These side effects are less common but serious; if you notice any sign of them, tell your team early:
- A severe allergic reaction during the infusion: shortness of breath, dizziness, hives or swelling; medicines are given before the infusion to prevent it. Tell the nurse straight away [1].
- Infection because of low white blood cells: a temperature of 38 °C or chills [1].
- A slow heartbeat or dizziness during the infusion [1].
- A new cough or shortness of breath, severe abdominal pain, and severe skin reactions [1].
- The drug contains some alcohol and may affect alertness; if you feel drowsy or confused after the infusion, do not drive [1].
For physicians
Boxed warning: anaphylaxis and severe hypersensitivity reactions (dyspnoea and hypotension needing treatment, angioedema and generalised urticaria) occurred in 2 to 4% of patients in trials, and fatal cases have been reported despite premedication; all patients should receive premedication with a corticosteroid, diphenhydramine and an H2 blocker, and anyone who has had a severe reaction should not receive paclitaxel again. The drug should also not be given to patients with solid tumours and baseline neutrophils below 1500, and blood counts should be checked frequently [1].
- Bone marrow suppression: mainly neutropenia, dose-dependent and dose-limiting; infections were fatal in 1% of all patients (sepsis, pneumonia, peritonitis) [1].
- Cardiac conduction abnormalities: severe conduction abnormalities in fewer than 1% of patients, sometimes needing a pacemaker; heart failure has been reported more often in patients who have received other drugs such as anthracyclines [1].
- Pulmonary effects: interstitial pneumonia, pulmonary fibrosis and pulmonary embolism; and radiation pneumonitis in patients receiving concurrent radiotherapy [1].
- Severe skin reactions: Stevens–Johnson syndrome and toxic epidermal necrolysis have been reported [1].
- Gastrointestinal and hepatic effects: bowel obstruction or perforation, ischaemic colitis, neutropenic enterocolitis and hepatic necrosis have been reported; with hepatic impairment the risk of toxicity (especially myelosuppression) is higher [1].
- Effects of the alcohol in the drug: each millilitre contains 396 mg of alcohol, and its possible effects on the central nervous system should be considered [1].
- Injection-site reactions and extravasation: usually mild, but phlebitis, cellulitis, necrosis and fibrosis have also been reported, sometimes with a delay of 7 to 10 days [1].
When should I call my doctor?
If any of the following happens, contact your treatment team straight away or go to an emergency department [1]:
- A temperature of 38 °C or higher, chills or any sign of infection
- Shortness of breath, chest tightness, severe flushing, facial swelling or hives during or after the infusion (tell the nurse straight away)
- Palpitations, an irregular heartbeat or feeling faint
- Numbness, tingling or weakness in the hands and feet that interferes with everyday tasks such as doing up buttons or walking
- Severe diarrhoea, mouth sores that stop you eating and drinking, or severe abdominal pain
- A new, persistent cough or shortness of breath
- A widespread rash, blisters or peeling skin
- Unusual bleeding or bruising
- Pain, swelling or redness at the injection site, even a few days after the infusion
Interactions, pregnancy and precautions
- Other medicines: some medicines raise or lower the amount of paclitaxel in the blood, such as antifungals (ketoconazole, itraconazole), the antibiotic clarithromycin, the HIV medicine ritonavir, the tuberculosis medicine rifampicin, the epilepsy medicine carbamazepine and the cholesterol medicine gemfibrozil; if you take any of these, your doctor needs to know. Give your doctor a full list of your medicines and herbal supplements [1].
- Doxorubicin: reports show that blood levels of doxorubicin may rise when it is combined with paclitaxel; heart function monitoring is recommended with this combination [1].
- Alcohol in the drug and premedication: because of the alcohol in the formulation and the antihistamine premedication, you may feel drowsy or confused after the infusion [1]; do not drive on the day of the infusion, and bring someone with you.
- Pregnancy: paclitaxel can harm an unborn baby; women who could become pregnant should avoid pregnancy during treatment [1]. Ask your doctor about the method and length of contraception after treatment.
- Breastfeeding: stopping breastfeeding during treatment is recommended [1].
- Fertility: in animal studies, paclitaxel reduced fertility in males and females [1]; talk about fertility preservation before starting treatment.
- Older people: in most studies severe bone marrow suppression, and in some studies severe neuropathy, were more common in people aged 65 and over [1].
Frequently asked questions
Why do I need to take dexamethasone tablets before paclitaxel?
Paclitaxel can cause an allergic reaction, and a severe one has happened in a few out of every 100 patients. Premedication (a steroid, an antihistamine and an H2 blocker) is needed for all patients to lower this risk [1]. Severe reactions have usually happened in the first hour of the infusion and in the first cycles [1].
Will the tingling and numbness in my hands and feet go away?
Is muscle and joint pain after the infusion normal?
Yes. This side effect was seen in more than half of patients; it usually starts 2 to 3 days after the infusion and goes away within a few days [1]. Ask your treatment team about a suitable painkiller.
Will I definitely lose my hair?
Almost all patients lose their hair with paclitaxel [1], so it is best to prepare for it in advance.
Scientific evidence
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Key studies
11 itemsA phase 3 trial of bevacizumab in ovarian cancer
Induction chemotherapy followed by standard chemoradiotherapy versus standard chemoradiotherapy alone in patients with locally advanced cervical cancer (GCIG INTERLACE): an international, multicentre, randomised phase 3 trial
Preoperative chemoradiotherapy for esophageal or junctional cancer
Perioperative Chemotherapy or Preoperative Chemoradiotherapy in Esophageal Cancer
Trastuzumab Deruxtecan or Ramucirumab plus Paclitaxel in Gastric Cancer
Increased Survival in Pancreatic Cancer with nab-Paclitaxel plus Gemcitabine
Atezolizumab plus bevacizumab and chemotherapy for metastatic, persistent, or recurrent cervical cancer (BEATcc): a randomised, open-label, phase 3 trial
Ivonescimab plus chemotherapy versus tislelizumab plus chemotherapy in advanced squamous non-small-cell lung cancer (HARMONi-6): interim overall survival analysis of a randomised, double-blind, phase 3 trial in China
Pembrolizumab for Early Triple-Negative Breast Cancer
Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer
Improved survival with bevacizumab in advanced cervical cancer
Clinical guidelines
1 itemCervical Cancer, Version 2.2026, NCCN Clinical Practice Guidelines In Oncology
Related cancer types
Treatment regimens (physicians)
References
12 referencesShow all references, 9 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
- 1Paclitaxel Injection USP — Prescribing Information
- 2
- 3
- 4
- 5
- 6Cyclophosphamide and Cisplatin Compared with Paclitaxel and Cisplatin in Patients with Stage III and Stage IV Ovarian Cancer
- 7
- 8Improved Outcomes From Adding Sequential Paclitaxel but Not From Escalating Doxorubicin Dose in an Adjuvant Chemotherapy Regimen for Patients With Node-Positive Primary Breast Cancer
- 9
- 10Comparison of Four Chemotherapy Regimens for Advanced Non–Small-Cell Lung Cancer
- 11Increased Survival in Pancreatic Cancer with nab-Paclitaxel plus Gemcitabine
- 12KEYTRUDA (pembrolizumab) injection, for intravenous use: Prescribing Information
This page is based on reputable scientific sources and was last updated on 27 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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