Paclitaxel

INTRODUCTION

Indications

Paclitaxel: Advanced ovarian cancer (with cisplatin). Non–small-cell lung cancer when potentially curative surgery and/or radiation therapy is not an option. Metastatic breast cancer unresponsive to other therapy. Node-positive breast cancer when administered sequentially to standard combination chemotherapy that includes doxorubicin. Treatment of AIDS-related Kaposi's sarcoma. Paclitaxel (albumin-bound): Metastatic breast cancer after treatment failure or relapse where therapy included an anthracycline.

Action

Interferes with the normal cellular microtubule function that is required for interphase and mitosis. Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

Adverse Reactions/Side Effects

CV: ECG changes, hypotension, bradycardia. GI: abnormal liver function tests, diarrhea, mucositis, nausea, vomiting. Derm: alopecia. Hemat: anemia, neutropenia, thrombocytopenia. MS: arthralgia, myalgia. Neuro: peripheral neuropathy. Resp: cough, dyspnea. Local: injection site reactions. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS AND STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately, especially regarding skin problems because certain skin reactions may indicate serious hypersensitivity reactions (Stevens-Johnson syndrome, toxic epidermal necrosis).

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report an unusually slow heart rate (bradycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

• Monitor respiratory side effects, including cough and difficult or labored breathing. Report severe or troublesome respiratory problems.

• Instruct patient to report signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia. Report these signs to the physician or nursing staff.

• Be alert for signs of peripheral neuropathy (numbness, tingling, decreased muscle strength). Establish baseline electroneuromyographic values using EMG and nerve conduction at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

• Assess any muscle or joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomical or biomechanical problems.

• Monitor IV injection site for pain, swelling, and inflammation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to ...