Regimen: 96-Hour Continuous-Infusion Paclitaxel and Weekly Paclitaxel
Ain KB et al. Thyroid 2000;10:587–594
Continuous 96-Hour IV Infusion
Optional premedication✫ (Primary prophylaxis against hypersensitivity reactions from paclitaxel):
Dexamethasone 20 mg/dose; administer orally for 2 doses on the evening before and the morning of chemotherapy before paclitaxel plus
Diphenhydramine 50 mg for 1 dose; administer by intravenous injection 30 minutes before paclitaxel and
Ranitidine 50 mg or cimetidine 300 mg for 1 dose; administer by intravenous infusion in 25–100 mL 0.9% sodium chloride injection (0.9% NS) or 5% dextrose injection (D5W) over 5–30 minutes given 30 minutes before paclitaxel
Paclitaxel 30–35 mg/m2 per day; administer by continuous intravenous infusion in a volume of 0.9% NS or D5W sufficient to produce a solution with concentration within the range 0.3–1.2 mg/mL over 24 hours for 4 consecutive days, on days 1–4, every 3 weeks, for up to 6 cycles (total dosage/cycle for 30 mg/m2 per day = 120 mg/m2 for 35 mg/m2 per day = 140 mg/m2)
Supportive Care
Antiemetic prophylaxis
Emetogenic potential is LOW
See Chapter 39 for antiemetic recommendations
Hematopoietic growth factor (CSF) prophylaxis
Primary prophylaxis is NOT indicated
See Chapter 43 for more information
Antimicrobial prophylaxis
Risk of fever and neutropenia is LOW
Antimicrobial primary prophylaxis to be considered:
See Chapter 47 for more information
Intermittent Weekly Administration
Note: Subsequent clinical experience suggests that optimal use of paclitaxel uses a 1-hour infusion of 175 mg/m2 given weekly for 3 weeks every month, with restaging each month, and continuing until there is progressive disease or limiting toxicity. This dose must be administered carefully with premedication against hypersensitivity reactions and growth factor support assessing patient before each dose with attention to occurrence of mucositis and neutropenia
Primary prophylaxis against hypersensitivity reactions from paclitaxel:
Dexamethasone 20 mg/dose; administer orally for 2 doses on the evening before and the morning on which chemotherapy is given (eg, one dose 12 to 14 hours before paclitaxel plus a second dose 6 to 7 hours before paclitaxel):
Diphenhydramine 50 mg; administer by intravenous injection 30 minutes before paclitaxel, and:
Ranitidine 50 mg or cimetidine 300 mg; administer intravenously in 25–100 mL of 0.9% NS or D5W over 5–30 minutes, 30 minutes before paclitaxel
Paclitaxel 175 mg/m2; administer by intravenous infusion in a volume of 0.9% NS or D5W sufficient to produce a solution with concentration of 0.3–1.2 mg/mL over 3 hours for 3 doses on 3 consecutive weeks every 28 days (monthly) (total dosage/cycle = 525 mg/m2)
Supportive Care
Antiemetic prophylaxis
Emetogenic potential is LOW
See Chapter 39 for antiemetic recommendations
Hematopoietic growth factor (CSF) prophylaxis
Primary prophylaxis may be indicated
See Chapter 43 for more information
Antimicrobial prophylaxis
Risk of fever and neutropenia is LOW
Antimicrobial primary prophylaxis to be considered:
See Chapter 47 for more information
Patient Population Studied
A study of 20 patients with metastatic anaplastic thyroid cancer