Paclitaxel and carboplatin chemotherapy
This information is about a chemotherapy treatment using paclitaxel and carboplatin that is used to treat ovarian or lung cancer. Paclitaxel is also known as Taxol, so this chemotherapy treatment is sometimes called the TaxolCarbo regimen.
The drugs that are used
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The treatment involves the two chemotherapy drugs paclitax (Taxol), and carboplatin.
How treatment is given
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Your chemotherapy treatment will be given to you as a day patient, or occasionally you may need to stay in hospital overnight. Before you start treatment you'll need to have a blood test on the same day or a few days beforehand. You'll also be seen by a doctor, specialist nurse or pharmacist. You'll also have tests to check how well your kidneys are working as the chemotherapy can affect them. These may include collecting your urine for 24 hours, or having a specific blood test known as an EDTA test. If the results of your tests are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.
The nurse will then put a thin, flexible tube (cannula) into a vein in your hand or arm.
You may find this uncomfortable or a little painful, but it shouldn't take long. Some people have their chemotherapy given through a thin, plastic tube that is inserted under the skin and into a vein near their collarbone (central line), or passed through a vein in the crook of their arm (PICC line). Your doctor or nurse will explain more about this to you.
Before the chemotherapy you'll be given anti-sickness (anti-emetic), usually by injection through the cannula or your central/PICC line. Some anti-sickness drugs can be given as tablets.
You'll also be given medicines to prevent the allergic reaction that some people have when given paclitaxel. This anti-allergy medicine is often given by injection. Part of it can sometimes be given as steroid tablets that you take at home before coming to the hospital. It's very important to take the tablets, and you must tell your doctor or nurse if for any reason you haven't taken them.
The chemotherapy drugs are then given separately:
Paclitaxel (a colourless fluid) is given as a drip (infusion) over about three hours.
Carboplatin (a colourless fluid) is also given as an infusion over about one hour.
The whole treatment takes 4–5 hours.
If you're having your treatment as a day patient you can then go home. The cannula will be removed before you go. If you have a central or PICC line it will usually stay in place, ready for the next cycle of your chemotherapy. You'll be shown how to look after the line.
You'll be given a supply of anti-sickness drugs to take home with you. You should take these regularly if you have been told to do so, even if you aren't feeling sick. This is because some medicines are much more effective at preventing sickness than stopping it once it begins.
How often treatment is given
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Your doctor may use the word 'regimen' (eg the TaxolCarbo regimen) when talking about your chemotherapy. This refers to the whole plan or schedule of the treatment that you are receiving.
On the first day of your treatment you'll be given paclitaxel and carboplatin, as described, for one day only. After this, you'll have a rest period with no chemotherapy for the next three weeks. This completes what is called a cycle of your treatment.
After the rest period the same treatment is repeated, which begins the next cycle of your chemotherapy. Usually 6–8 cycles are given over a period of 5–6 months. This makes up a course of treatment.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone who has treatment with paclitaxel and carboplatin.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you. If you notice any effects that aren't listed here, discussthem with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
Paclitaxel and carboplatin can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you'll be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment, and your resistance to infection is usually at its lowest 10–14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel unwell even with a normal temperature.
You'll have a blood test before having morec hemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if the number of your blood cells (blood count) is still low.
Bruising and bleeding
Paclitaxel and carboplatin chemotherapy can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You may need to have a platelet transfusion if your platelet count is low.
Paclitaxel and carboplatin can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) and being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
This usually starts 3–4 weeks after starting treatment, although it may occur earlier. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and your hair will start to grow again once the treatment has finished. Your hair may grow back straighter, curlier, finer, or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
Paclitaxel and carboplatin can cause diarrhoea. This can usually be easily controlled with medicine, but tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Numbness or tingling in hands or feet
This is due to the effect of carboplatin or paclitaxel on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or other fiddly tasks.
Tell your doctor if you notice any numbness or tingling in your hands or feet. It's important to report your symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug.
This effect usually begins to improve slowly a few months after the treatment is finished. Sometimes symptoms can persist, talk to your doctor if this happens.
Pain in joints and muscles
You may have these symptoms a few days after treatment with paclitaxel. This doesn't usually last long and your doctor can prescribe mild painkillers to help.
Some people can have an allergic reaction to paclitaxel while it’s being given. Signs of this can include skin rashes and itching, a high temperature, shivering, dizziness, a headache and breathlessness.
Usually you'll be given steroid tablets tablets to take at home the day before treatment to reduce the chance of this happening. It’s important to take the steroid tablets as you have been directed. Instead of steroid tablets, you may be given a steroid by injection into a vein (intravenously) 30-60 minutes before the paclitaxel. Other drugs, such as antihistamines, may also be injected into a vein before your treatment to prevent an allergic reaction.
You'll be closely monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these symptoms. If you do have a reaction, it can be treated quickly.
Less common side effects
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Pain at injection site
Paclitaxel can cause pain along the vein that is used to give you your chemotherapy. If you feel any pain, tell your doctor or nurse straight away so that they can check the infusion site. They may slow the infusion down to reduce pain.
Some people find that paclitaxel causes headaches. Let your doctor or nurse know. They can give you painkillers to relieve this.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Changes in hearing
This is rare if you have standard doses of carboplatin. But if you have high-dose treatment you may develop ringing in the ears (tinnitus) and may lose the ability to hear some highpitched sounds. This side effect usually decreases when the treatment ends. Tell your doctor know if you notice any loss of hearing or tinnitus.
Changes in heart rate
Rarely, paclitaxel can cause a temporary slowing of the heart rate known as bradycardia. This usually does not cause any harm.
Effect on your kidneys
This doesn't usually cause any symptoms and the effect is generally mild. However, if the effect is severe, the kidneys can be permanently damaged unless the treatment is stopped. For this reason, your kidneys will be checked by a blood test before each treatment.
If necessary, you may be given medicine to help you pass urine. You may be asked to drink extra fluid before and after treatment. It’s important to do this, so let your doctor know if this is a problem – for example, if you're feeling sick.
Let your doctor know if you develop any pain in your tummy (abdomen) pain. It can usually be controlled with mild painkillers
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having paclitaxel and carboplatin, as it may harm the developing baby. It's important to use effective contraception while taking these drugs and for at least a few months afterwards. You can discuss this with your doctor or nurse.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
Loss of periods in women
Because of the effect of chemotherapy on the ovaries, women may find that their periods become irregular and may eventually stop. In some women this may be temporary, but for others it will be permanent. This will result in menopausal symptoms, such as hot flushes, sweats and vaginal dryness.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you're having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based on our paclitaxel and carboplatin fact sheet, which has been compiled using information from a number of reliable sources including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). (accessed October 2011).
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.