Definition & MOA

• Microtubule‐stabilizing chemotherapy agents derived from Taxus species.
• Bind β‐tubulin → prevent depolymerization → arrest in G₂/M phase → apoptosis.

Common Agents & Indications

• Paclitaxel – breast, ovarian, NSCLC, Kaposi sarcoma.
• Docetaxel – breast, prostate, NSCLC, gastric.
• Cabazitaxel – metastatic castration‐resistant prostate cancer post‐docetaxel.
• Nab‐paclitaxel – breast, pancreatic, NSCLC (solvent‐free formulation)

Administration & Premedication

• Paclitaxel: cremophor formulation → requires dexamethasone, H₁ & H₂ blocker; non‐PVC tubing.
• Docetaxel: polysorbate‐80 → dexamethasone x3 days to reduce edema/HSR.
• Cabazitaxel: steroid + H₁ & H₂ blocker before infusion.
• Nab‐paclitaxel: no routine premedication.

Major Toxicities & Management

• Myelosuppression (neutropenia) – CBC before each cycle; G‐CSF for high‐risk regimens.
• Peripheral neuropathy – monitor cumulative dose; dose modify if ≥grade 2.
• Hypersensitivity reactions – prevent with premedication; treat with antihistamines, steroids, epinephrine if severe; consider desensitization or nab‐paclitaxel.
• Fluid retention (docetaxel) – prevented by steroid premedication.
• Diarrhea (cabazitaxel) – antidiarrheals, hydration.

Drug Interactions & Special Populations

• CYP3A4 metabolism (esp. docetaxel, cabazitaxel) – avoid strong inhibitors/inducers.
• Dose adjust or avoid in hepatic impairment (AST/ALT/bilirubin elevated).
• Elderly: higher neutropenia risk; close monitoring.
• Avoid in pregnancy.

Practice Pearls

• Nab‐paclitaxel for patients with prior HSR to cremophor/polysorbate formulations.
• Weekly low‐dose paclitaxel can reduce neuropathy vs q3‐week high‐dose.
• Use rapid desensitization to maintain taxane therapy after moderate HSR.

Key Takeaway: Taxanes are cornerstone agents in multiple cancers; their safe use relies on correct premedication, toxicity monitoring, and dose adjustments in special populations.