Paclitaxel / nab-paclitaxel
A microtubule poison discovered in the Pacific yew tree, among the most used chemotherapies in breast, lung, and ovarian cancer.
Weekly paclitaxel is a backbone of neoadjuvant TNBC therapy; nab-paclitaxel (albumin-bound) avoids steroid premedication and partners with immunotherapy (IMpassion130) and, in 2026, with relacorilant in ovarian cancer and TTFields in pancreatic cancer.
1.Paclitaxel binds β-tubulin in microtubules
- Route
- IV infusion
- Schedule
- 80 mg/m² weekly (breast, with carboplatin in TNBC) or 175 mg/m² every 3 weeks; nab-paclitaxel 100-125 mg/m² days 1, 8, 15 without premedication
- Dose modifications
- Hold for grade ≥3 neuropathy or neutropenia <1,500/µL
- Monitoring
- Blood counts, neuropathy, hypersensitivity (solvent-based formulation requires steroid/antihistamine premedication)
Source: www.fda.gov/drugs/resources-information-approved-drugs/oncology-cancer-hematologic-malignancies-approval-notifications. Doses are for orientation; the current label governs.
- Medicare
- Part B (clinician-administered)
Given by infusion or injection in a clinic or hospital outpatient department, so it is a Part B drug: Medicare pays 80% after the Part B deductible and the patient owes 20% coinsurance, uncapped in Original Medicare unless a Medigap policy applies. HCPCS J9267 for paclitaxel (generic). Nab-paclitaxel (Abraxane) is also Part B; generics launched in 2022.
- Commercial insurance
- covered on label
Multi-source generic; covered under the medical benefit without prior authorisation in most plans, as part of standard regimens. Some plans apply prior authorisation to nab-paclitaxel because of its higher price.
Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B). Not medical or financial advice; verify with your plan.
- Appraised for
- Nab-paclitaxel with gemcitabine for untreated metastatic pancreatic cancer
- Notes
- Conventional paclitaxel is generic and funded routinely across breast, ovarian, lung and other cancers.
- NHS England
- Routinely funded for the appraised indication (or via managed access)
Sources: NICE TA476 · SMC advice: paclitaxel / nab-paclitaxel. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
- 29 Dec 1992ApprovalUS
Refractory ovarian cancer source
- 13 Apr 1994ApprovalUS
Metastatic breast cancer source
- 7 Jan 2005ApprovalUS
nab-Paclitaxel (Abraxane) for metastatic breast cancer source
- 6 Sept 2013ApprovalUS
nab-Paclitaxel with gemcitabine for metastatic pancreatic cancer source
- Apr 2022ApprovalUS
First nab-paclitaxel generics source
Approvals
| Region | Year | Indication |
|---|---|---|
| US | 1992 | Ovarian cancer (now broad) |
| Adverse event |
|---|
| Neutropenia |
| Peripheral neuropathy |
| Alopecia |
| Myalgia/arthralgia |
| Hypersensitivity reactions (Cremophor) |
| Nausea |
Events listed without rates were not read from a primary source; see the label. Blank cells mean the figure was not sourced, not that it is zero.
| Country | Reimbursement | List price | Assistance |
|---|---|---|---|
| United Statesgeneric | Medicare Part B; generic paclitaxel and nab-paclitaxel available | not disclosed | — |
| United Kingdomgeneric | NHS standard; generic | not disclosed | — |
List prices are manufacturer or Medicare figures where publicly disclosed; net prices after rebates are usually lower. Reimbursement changes; check the payer.
Trials
topRecruiting now (live from ClinicalTrials.gov)
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Women with newly diagnosed advanced or recurrent endometrial cancer should receive a PD-1 antibody (dostarlimab or pembrolizumab) with their chemotherapy, and mismatch repair testing is now essential because women with dMMR tumours gain a very large and durable benefit. The gain in mismatch-repair-proficient tumours is real but smaller, and molecular classification (POLE, p53, MMR) is increasingly used to decide who benefits most.
Patients with operable stage II-III lung cancer without EGFR or ALK alterations should have chemo-immunotherapy discussed before surgery rather than only afterwards. Three pre-operative cycles do not compromise the operation and improve cure rates. Whether to continue immunotherapy after surgery, as the perioperative trials do, and whether patients with pCR need any further treatment, remain open questions.
For stage II-III triple-negative breast cancer, chemotherapy plus pembrolizumab before surgery and pembrolizumab alone afterwards is now the standard approach worldwide, and the survival gain is real, not just a surrogate. It does not apply to stage I disease or to hormone-receptor-positive or HER2-positive cancers. The price is a year of immunotherapy with a meaningful chance of a permanent endocrine side effect such as hypothyroidism or adrenal insufficiency.
Latest papers
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