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Ovarian recurrent PACLitaxel weekly

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Read more about the as required review process in this factsheet.

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Cycle 1 and further cycles

Drug Dose Route Day
PACLitaxel 80 mg/m2 IV infusion 1
Frequency:
7 days 
Cycles:
Continuous until disease progression or unacceptable toxicity
Notes:

If dose delays are required for toxicity, consideration should be given to scheduling breaks in therapy according to individual tolerance (i.e. prescribing 3 weeks out of 4 or 4 weeks out of 6)

Drug status:

Paclitaxel is on the PBS general schedule opens in a new tab or window

Cost:
~ $50 per cycle "How this cost is calculated"

The cost displayed on the protocol is intended as rudimentary guide only for the Australian context.

The cost includes anti-cancer drugs only (not antiemetics, supportive medications or consumables), unless otherwise indicated.

Drug unit costs are taken directly from the Pharmaceutical Benefits Scheme (PBS) website (www.pbs.gov.au). These costs are reviewed and updated on eviQ at 6 monthly intervals. Anti-cancer drugs that are not included on the PBS do not have a cost included in eviQ protocols.

Where there are differing unit costs based on vial sizes and tablet strengths, the mean unit cost is used. The cost of oral continuous therapy is based on a 28 day month.

Where oral drugs are available on the PBS for both 30- and 60-day prescriptions, the unit cost for the 30-day supply is used.

The protocol cost is derived from drug dose calculations based upon a default body surface area (BSA) of 1.8 m2; weight of 75 kg; and creatinine clearance of 75 mL/min.

One off loading doses and ongoing maintenance doses are not included in protocol cost calculations.

The cost displayed is the actual drug cost and does not necessarily reflect the cost incurred by the patient as many anti-cancer drugs are reimbursed on the PBS.

The supportive therapies (e.g. antiemetics, premedications, growth factor support etc.), infusion times, diluents, volumes and routes of administration, if included, are listed as defaults. They may vary between institutions and can be substituted to reflect individual institutional policy.

Antiemetics if included in the treatment schedule are based upon recommendations from national and international guidelines. These are defaults only and may be substituted to reflect individual institutional policy. Select here for recommended doses of alternative antiemetics.

Cycle 1

Day 1
Loratadine 10 mg (PO) 60 minutes before chemotherapy
Dexamethasone 8 mg (PO) 60 minutes before chemotherapy
PACLitaxel 80 mg/m2 (IV infusion) in 250 mL sodium chloride 0.9% over 60 minutes

(in non-PVC containers only)

Cycle 2

Day 1
Loratadine 10 mg (PO) 60 minutes before chemotherapy
Dexamethasone 4 mg (PO) 60 minutes before chemotherapy
PACLitaxel 80 mg/m2 (IV infusion) in 250 mL sodium chloride 0.9% over 60 minutes

(in non-PVC containers only)

Cycle 3 and 4

Day 1
Loratadine 10 mg (PO) 60 minutes before chemotherapy
Metoclopramide 10 mg (PO)

one tablet when necessary (maximum of 30 mg/24 hours, up to 5 days)
PACLitaxel 80 mg/m2 (IV infusion) in 250 mL sodium chloride 0.9% over 60 minutes

(in non-PVC containers only)

Cycle 5 and further cycles

Day 1
Metoclopramide 10 mg (PO)

one tablet when necessary (maximum of 30 mg/24 hours, up to 5 days)
PACLitaxel 80 mg/m2 (IV infusion) in 250 mL sodium chloride 0.9% over 60 minutes

(in non-PVC containers only)
Frequency:
7 days 
Cycles:
Continuous until disease progression or unacceptable toxicity

Cycle 1 and further cycles

Drug Dose Route Day
PACLitaxel 80 mg/m2 IV infusion 1
Frequency:
7 days 
Cycles:
Continuous until disease progression or unacceptable toxicity
Notes:

If dose delays are required for toxicity, consideration should be given to scheduling breaks in therapy according to individual tolerance (i.e. prescribing 3 weeks out of 4 or 4 weeks out of 6)

Drug status:

Paclitaxel is on the PBS general schedule opens in a new tab or window

Cost:
~ $50 per cycle "How this cost is calculated"

The cost displayed on the protocol is intended as rudimentary guide only for the Australian context.

The cost includes anti-cancer drugs only (not antiemetics, supportive medications or consumables), unless otherwise indicated.

Drug unit costs are taken directly from the Pharmaceutical Benefits Scheme (PBS) website (www.pbs.gov.au). These costs are reviewed and updated on eviQ at 6 monthly intervals. Anti-cancer drugs that are not included on the PBS do not have a cost included in eviQ protocols.

Where there are differing unit costs based on vial sizes and tablet strengths, the mean unit cost is used. The cost of oral continuous therapy is based on a 28 day month.

Where oral drugs are available on the PBS for both 30- and 60-day prescriptions, the unit cost for the 30-day supply is used.

The protocol cost is derived from drug dose calculations based upon a default body surface area (BSA) of 1.8 m2; weight of 75 kg; and creatinine clearance of 75 mL/min.

One off loading doses and ongoing maintenance doses are not included in protocol cost calculations.

The cost displayed is the actual drug cost and does not necessarily reflect the cost incurred by the patient as many anti-cancer drugs are reimbursed on the PBS.

The supportive therapies (e.g. antiemetics, premedications, growth factor support etc.), infusion times, diluents, volumes and routes of administration, if included, are listed as defaults. They may vary between institutions and can be substituted to reflect individual institutional policy.

Antiemetics if included in the treatment schedule are based upon recommendations from national and international guidelines. These are defaults only and may be substituted to reflect individual institutional policy. Select here for recommended doses of alternative antiemetics.

Cycle 1

Day 1
Loratadine 10 mg (PO) 60 minutes before chemotherapy
Dexamethasone 8 mg (PO) 60 minutes before chemotherapy
PACLitaxel 80 mg/m2 (IV infusion) in 250 mL sodium chloride 0.9% over 60 minutes

(in non-PVC containers only)

Cycle 2

Day 1
Loratadine 10 mg (PO) 60 minutes before chemotherapy
Dexamethasone 4 mg (PO) 60 minutes before chemotherapy
PACLitaxel 80 mg/m2 (IV infusion) in 250 mL sodium chloride 0.9% over 60 minutes

(in non-PVC containers only)

Cycle 3 and 4

Day 1
Loratadine 10 mg (PO) 60 minutes before chemotherapy
Metoclopramide 10 mg (PO)

one tablet when necessary (maximum of 30 mg/24 hours, up to 5 days)
PACLitaxel 80 mg/m2 (IV infusion) in 250 mL sodium chloride 0.9% over 60 minutes

(in non-PVC containers only)

Cycle 5 and further cycles

Day 1
Metoclopramide 10 mg (PO)

one tablet when necessary (maximum of 30 mg/24 hours, up to 5 days)
PACLitaxel 80 mg/m2 (IV infusion) in 250 mL sodium chloride 0.9% over 60 minutes

(in non-PVC containers only)
Frequency:
7 days 
Cycles:
Continuous until disease progression or unacceptable toxicity
  • Treatment of platinum resistant, recurrent ovarian, primary peritoneal or fallopian tube cancer.
Venous access required

IV cannula (IVC) or central venous access device (CVAD) is required to administer this treatment.

Read more about central venous access device line selection
Hypersensitivity/infusion related reaction

High risk with paclitaxel.

Read more about Hypersensitivity reaction
Premedication

The product information for paclitaxel recommends a higher dose of dexamethasone to be used. However, many clinicians use a reducing premedication regimen with an anecdotally acceptable rate of hypersensitivity reactions (HSRs). 

Please refer to the treatment schedule for suggested premedication regimen. This may be substituted to reflect institutional policy.

Read more about premedication for prophylaxis of taxane hypersensitivity reactions (infusion related reactions and anaphylaxis)
Emetogenicity LOW

Suggested default antiemetics have been added to the treatment schedule, and may be substituted to reflect institutional policy.

Note: dexamethasone has been included both as an antiemetic and premedication for hypersensitivity in this protocol.

Ensure that patients also have sufficient antiemetics for breakthrough emesis:

Metoclopramide 10 mg three times a day when necessary (maximum of 30 mg/24 hours, up to 5 days) OR

Prochlorperazine 10 mg PO every 6 hours when necessary.

Read more about preventing anti-cancer therapy induced nausea and vomiting
Peripheral neuropathy

Assess prior to each treatment. If a patient experiences grade 2 or greater peripheral neuropathy, a dose reduction, delay, or omission of treatment may be required; review by medical officer before commencing treatment.

Read more about peripheral neuropathy

Link to Anti-cancer drug induced peripheral neuropathy screening tool
Blood tests

FBC, EUC, eGFR and LFTs at baseline, prior to each treatment for 4 weeks, then monthly and as clinically indicated.
Hepatitis B screening and prophylaxis

Routine screening for HBsAg and anti-HBc is NOT usually recommended for patients receiving this treatment.

Read more about hepatitis B screening and prophylaxis in cancer patients requiring cytotoxic and/or immunosuppressive therapy
Vaccinations

Live vaccines are contraindicated in cancer patients receiving immunosuppressive therapy and/or who have poorly controlled malignant disease. Possible suboptimal response to inactivated vaccines.

For more information about vaccinations in people with cancer refer to the Australian Immunisation Handbook opens in a new tab or window.
Fertility, pregnancy and lactation

Cancer treatment can have harmful effects on fertility and this should be discussed with all patients of reproductive potential prior to commencing treatment. There is a risk of fetal harm in pregnant women. A pregnancy test should be considered prior to initiating treatment in females of reproductive potential if sexually active. It is important that all patients of reproductive potential use effective contraception whilst on therapy and after treatment finishes. Effective contraception methods and adequate contraception timeframe should be discussed with all patients of reproductive potential. Possibility of infant risk should be discussed with breastfeeding patients.

Read more about the impact of cancer treatment on fertility opens in a new tab or window
Evidence for dose modifications is limited, and the recommendations made on eviQ are intended as a guide only. They are generally conservative with an emphasis on safety. Any dose modification should be based on clinical judgement, and the individual patient’s situation including but not limited to treatment intent (curative vs palliative), the anti-cancer regimen (single versus combination therapy versus chemotherapy versus immunotherapy), biology of the cancer (site, size, mutations, metastases), other treatment related side effects, additional co-morbidities, performance status and patient preferences.Suggested dose modifications are based on clinical trial findings, product information, published guidelines and reference committee consensus . The dose reduction applies to each individual dose and not to the total number of days or duration of treatment cycle unless stated otherwise. Non-haematological gradings are based on Common Terminology Criteria for Adverse Events (CTCAE) opens in a new tab or window unless otherwise specified. Renal and hepatic dose modifications have been standardised where possible. For more information see dosing considerations & disclaimer.

Note: All dose reductions are calculated as a percentage of the starting dose.

Haematological toxicity
ANC x 109/L (pre-treatment blood test)
1.0 to less than 1.5 Refer to local institutional guidelines; it is the view of the expert clinicians that treatment should continue if patient is clinically well
0.5 to less than 1.0 Delay treatment until recovery
less than 0.5 Delay treatment until recovery and consider reducing paclitaxel by 25% for subsequent cycles
Febrile neutropenia Delay treatment until recovery and consider reducing paclitaxel by 25% for subsequent cycles
Platelets x 109/L (pre-treatment blood test)
75 to less than 100 The general recommendation is to delay, however if the patient is clinically well it may be appropriate to continue treatment; refer to treating team and/or local institutional guidelines
50 to less than 75 Delay treatment until recovery
less than 50 Delay treatment until recovery and consider reducing paclitaxel by 25% for subsequent cycles
Kidney dosing recommendations 
  • Suggested dose modifications are based on the International Consensus Guideline on Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD).
  • Where one or more drugs in a protocol is recommended to be avoided, consider using a clinically appropriate alternative treatment protocol instead.
  • Before dose adjusting or omitting a drug, consider treatment intent.
  • In kidney replacement therapy consult a multidisciplinary team consisting of oncology/haematology with nephrology and/or clinical pharmacology for the management of dosing. 
  • For complete information on individual drug recommendations please review the individual drug monograph in the ADDIKD guideline.
eGFR
(mL/min/1.73m2)		 Paclitaxel
≥ 60

Full dose
45 - 59

Full dose
30 - 44

Full dose
15 - 29

Full dose 
< 15
(without kidney replacement therapy)

Full dose

Potential for increased risk of adverse events
Hepatic impairment
Hepatic dysfunction
Mild Reduce paclitaxel by 25%
Moderate Reduce paclitaxel by 50%
Severe Omit paclitaxel
Peripheral neuropathy
Grade 2 which is present at the start of the next cycle Reduce paclitaxel by 25%;
if persistent, reduce paclitaxel by 50%
Grade 3 or Grade 4 Omit paclitaxel
Mucositis and stomatitis
Grade 2 Delay treatment until toxicity has resolved to Grade 1 or less and reduce the dose for subsequent cycles as follows:
1st occurrence: No dose reduction
2nd occurrence: Reduce paclitaxel by 25%
3rd occurrence: Reduce paclitaxel by 50%
4th occurrence: Omit paclitaxel
Grade 3 or Grade 4 Delay treatment until toxicity has resolved to Grade 1 or less and reduce the dose for subsequent cycles as follows:
1st occurrence: Reduce paclitaxel by 50%
2nd occurrence: Omit paclitaxel

The drug interactions shown below are not an exhaustive list. For a more comprehensive list and for detailed information on specific drug interactions and clinical management, please refer to the specific drug product information and the following key resources: 

For more information see References & Disclaimer.

Paclitaxel
  Interaction Clinical management
CYP3A4 inhibitors (e.g. aprepitant, azole antifungals, clarithromycin, erythromycin, grapefruit juice, ritonavir etc.) Increased toxicity of paclitaxel possible due to reduced clearance Monitor for paclitaxel toxicity
CYP3A4 inducers (e.g. carbamazepine, phenytoin, phenobarbitone, rifampicin, St John’s wort etc.) Reduced efficacy of paclitaxel possible due to increased clearance Monitor for decreased clinical response to paclitaxel
CYP2C8 inhibitors (e.g. pazopanib, lapatinib, gemfibrozil, montelukast etc.) Increased toxicity of paclitaxel possible due to reduced clearance Monitor for paclitaxel toxicity
Metronidazole, disulfiram Intolerance reaction to alcohol content of diluent of intravenous paclitaxel Avoid combination
Doxorubicin Administration schedule can influence systemic exposure to doxorubicin Minimise by administering doxorubicin first in regimens using the combination
Cisplatin Administration schedule may influence the development of myelosuppression Minimise toxicity by administering paclitaxel first in regimens using the combination
Infliximab Reduced paclitaxel concentrations possible due to increased clearance Monitor for reduced efficacy of paclitaxel
General
  Interaction Clinical management
Warfarin Anti-cancer drugs may alter the anticoagulant effect of warfarin. Monitor INR regularly and adjust warfarin dosage as appropriate; consider alternative anticoagulant.
Direct oral anticoagulants (DOACs) e.g. apixaban, rivaroxaban, dabigatran

Interaction with both CYP3A4 and P-gp inhibitors /inducers.

DOAC and anti-cancer drug levels may both be altered, possibly leading to loss of efficacy or toxicity (i.e. increased bleeding).

Apixaban: avoid concurrent use with strong CYP3A4 opens in a new tab or window and P‑gp opens in a new tab or window inhibitors. If treating VTE, avoid use with strong CYP3A4 opens in a new tab or window and P‑gp opens in a new tab or window inducers. 

Rivaroxaban: avoid concurrent use with strong CYP3A4 opens in a new tab or window and P‑gp opens in a new tab or window  inhibitors.

Dabigatran: avoid combination with strong P‑gp opens in a new tab or window inducers and inhibitors.

If concurrent use is unavoidable, monitor closely for efficacy/toxicity of both drugs.
Digoxin Anti-cancer drugs can damage the lining of the intestine; affecting the absorption of digoxin. Monitor digoxin serum levels; adjust digoxin dosage as appropriate.
Antiepileptics Both altered antiepileptic and anti-cancer drug levels may occur, possibly leading to loss of efficacy or toxicity. Where concurrent use of an enzyme-inducing antiepileptic cannot be avoided, monitor antiepileptic serum levels for toxicity, as well as seizure frequency for efficacy; adjust dosage as appropriate.
Also monitor closely for efficacy of the anti-cancer therapy.
Antiplatelet agents and NSAIDs Increased risk of bleeding due to treatment related thrombocytopenia. Avoid or minimise combination.
If combination deemed essential, (e.g. low dose aspirin for ischaemic heart disease) monitor for signs of bleeding.
Serotonergic drugs, including selective serotonin reuptake inhibitors (SSRIs e.g. paroxetine) and serotonin noradrenaline reuptake inhibitors (SNRIs e.g. venlafaxine) Increased risk of serotonin syndrome with concurrent use of 5-HT3 receptor antagonists (e.g. palonosetron, ondansetron, granisetron, tropisetron, dolasetron, etc.) Avoid combination.
If combination is clinically warranted, monitor for signs and symptoms of serotonin syndrome (e.g. confusion, agitation, tachycardia, hyperreflexia).
For more information link to TGA Medicines Safety Update opens in a new tab or window

eviQ provides safe and effective instructions on how to administer cancer treatments. However, eviQ does not provide every treatment delivery option, and is unable to provide a comprehensive list of cancer treatment agents and their required IV line giving set/filter or address chemical compatibilities related to IV drug preparation and administration. There may be alternative methods of treatment administration, and alternative supportive treatments that are also appropriate. Please refer to the individual product information monographs via the TGA opens in a new tab or window and Australian Injectable Drugs Handbook opens in a new tab or window websites for further information.

eviQ is currently updating the way information is presented in the administration section, if you notice any discrepancies please let us know, via feedback@eviq.org.au.

Day 1

Approximate treatment time: 90 minutes

Any toxicity grade 2 or greater may require dose reduction, delay or omission of treatment and review by medical officer before commencing treatment.

Anti-cancer drug patient assessment tool prior to each day of treatment.

Anti-cancer drug induced neuropathy screening tool prior to each treatment.

Prime required IV lines with sodium chloride 0.9%:

  • paclitaxel requires a 0.2 or 0.22 micrometre inline filter AND either a non-polyvinyl chloride (non-PVC) OR a low-sorbing polyethylene (PE) lined giving set
  • attach a second IV line via a luer lock connector as close as possible to the site of injection, this may be required in case of a hypersensitivity reaction or an infusion-related reaction (IRR). 

Insert IV cannula or access TIVAD or CVAD.

Pre treatment medication

Verify taxane premedication taken or administer as prescribed.

Verify antiemetics taken or administer as prescribed.

Paclitaxel

Administer paclitaxel (irritant with vesicant properties):
  • via controlled IV infusion over 60 minutes
  • flush with ~ 100 mL of sodium chloride 0.9%
  • observe for hypersensitivity reactions.
Stop infusion at first sign of reaction:
  • if symptoms are mild and resolve when infusion is stopped, consider recommencing infusion after review by medical officer at a slower rate
  • for severe reactions seek medical assistance immediately and do not restart infusion
  • hypersensitivity reactions are more common during the first 2 cycles in the first 30 minutes.

Remove IV cannula and/or deaccess TIVAD or CVAD. 

Continue safe handling precautions until 7 days after completion of drug(s).

Discharge information

Antiemetics - as/if prescribed.

Premedication - for next cycle of chemotherapy.

Patient information

Ensure patient receives protocol patient information sheet.

The side effects listed below are not a complete list of all possible side effects for this treatment. Side effects are categorised into the approximate onset of presentation and should only be used as a guide.

Immediate (onset hours to days)
Nausea and vomiting

Read more about prevention of treatment induced nausea and vomiting
Hypersensitivity reaction

Anaphylaxis and infusion related reactions can occur with taxanes.

Read more about premedication for prophylaxis of taxane hypersensitivity reactions
Taste and smell alteration

Read more about taste and smell changes

Early (onset days to weeks)
Neutropenia

Abnormally low levels of neutrophils in the blood. This increases the risk of infection. Any fever or suspicion of infection should be investigated immediately and managed aggressively. 

Read more about immediate management of neutropenic fever
Thrombocytopenia

A reduction in the normal levels of functional platelets, increasing the risk of abnormal bleeding.  

Read more about thrombocytopenia
Peripheral neuropathy

Typically symmetrical sensory neuropathy, affecting the fingers and toes, sometimes progressing to the hands and feet.  It is associated with several classes of anti-cancer drugs. These include taxanes, platinum-based compounds, vinca alkaloids and some drugs used to treat multiple myeloma.

Read more about peripheral neuropathy
Fatigue

Read more about fatigue
Oral mucositis and stomatitis

Erythematous and ulcerative lesions of the gastrointestinal tract (GIT). It commonly develops following anti-cancer treatment, radiation therapy to the head, neck or oesophagus, and high-dose chemotherapy followed by a blood and marrow transplant (BMT).

Read more about oral mucositis and stomatitis
Diarrhoea

Read more about treatment induced diarrhoea
Skin rash

Anti-cancer drugs can cause a number of changes in the skin with maculo-papular rash the most common type of drug-induced skin reaction. 

Read more about skin rash
Arthralgia and myalgia

Generalised joint pain or and/or stiffness and muscle aches, often worse upon waking or after long periods of inactivity. Can improve with movement. May be mild or severe, intermittent or constant and accompanied by inflammation. 

Read more about arthralgia and myalgia

Late (onset weeks to months)
Anaemia

Abnormally low levels of red blood cells (RBCs) or haemoglobin in the blood. 

Read more about anaemia
Cognitive changes (chemo fog)

Changes in cognition characterised by memory loss, forgetfulness and feeling vague. This is also referred to as 'chemo brain' or 'chemo fog'.

Read more about cognitive changes (chemo fog) 
Alopecia

Hair loss may occur from all parts of the body. Patients can also experience mild to moderate discomfort of the hair follicles, and rarely pain as the hair is falling out.

Read more about alopecia and scalp cooling
Nail changes

Hyperpigmentation, paronychia, onycholysis, splinter haemorrhage, pyogenic granuloma formation, subungual haematoma and subungual hyperkeratosis are some of the nail changes associated with anti-cancer drugs.   

Read more about nail toxicities

eviQ is currently updating the way information is presented in the evidence section to improve usability, consistency and facilitate easier update and maintenance. An updated evidence template is being implemented in a staged approach, first across new protocols, then existing protocols as they are reviewed. Find out more

The evidence supporting this treatment comes from a phase II trial of weekly paclitaxel administered in patients with platinum and paclitaxel-resistant ovarian and primary peritoneal cancer. 48 patients with platinum and paclitaxel-resistant ovarian cancer (defined as progression during, or recurrence within 6 months following prior treatment with both agents) received weekly paclitaxel until disease progression (assuming acceptable toxicity). Following the initial 12 weekly doses, treatment could be given for 3 weeks, with a 1 week break.r

The efficacy and toxicity of paclitaxel given weekly versus three weekly has also been reported in a randomised phase III trial by Rosenberg et al. Between February 1995 and June 1998, a total of 205 patients were randomised to receive weekly paclitaxel (n=104) and three weekly paclitaxel (n=101).r

Efficacy

Response r Number of cases (%)
Complete response 2 4
Partial response 8 17
Stable disease 22 46
Progressive disease 15 31
Inevaluable 1 2

In the study by Rosenberg et al, there was no statistically significant difference in the number of patients who responded to treatment or the median survival between groups (13.5 months for weekly group vs 14.7 months for 3 weekly group; p=0.98). Median time to progression was 6.1 months in the weekly group vs 8.1 months in the three weekly group (p=0.85). Some of these differences may be attributed to the lower median total dose given in the weekly arm.r

Toxicity

Serious adverse events were relatively uncommon.

Toxicity r Paclitaxel weekly
Grade 2 (%) Grade 3/4 (%)
Neutropenia 0 3
Thrombocytopenia 1 0
Anaemia 35 5
Emesis 8 1
Gastrointestinal 19 7
Allergy 5 0
Neurologic 19 3
Fatigue 15 7
Pain 11 5
Myalgia/arthralgia 0 0
Dyspnoea 5 5
Infection 3 1
Cardiovascular 0 3
Pulmonary 1 3

© Gynaecology Oncology 2006

The weekly paclitaxel regimen was found to have a better safety profile compared with the three weekly regimen. There was with a significantly lower incidence of neutropenia, arthralgia and grade 3 neuropathy and alopecia. Nail changes, however, was more frequently reported in the weekly paclitaxel group.r

Toxicity r Weekly paclitaxel (%) 3 weekly paclitaxel (%) p-value
Neutropenia (grade 3 to 4) 18 45 <0.001
Neuropathy (grade 3) 11 29 <0.001
Alopecia (grade 3) 46 79 <0.001
Arthralgia/Myalgia (grade 1 to 3) 59 84 <0.001
Nails (grade 1 to 3) 36 2 <0.001
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Version 10

Date Summary of changes
01/05/2024

Protocol updated with ADDIKD guideline recommendations. New kidney dosing recommendation table added to dose modification section.

PDF of previous protocol.

Version number changed to V.10.

Version 9

Date Summary of changes
15/02/2024 Protocol assessed by eviQ medical oncology reference committee and deemed suitable to be reviewed as required. Flag added, review date removed and version number increased to V.9. Read more about as required review protocol status in this factsheet.

Version 8

Date Summary of changes
08/02/2023

As per reference committee consensus, removed:

  • Ranitidine recall flag
  • Ranitidine from treatment schedule detail.
Version number increased to V.8.

Version 7

Date Summary of changes
13/09/2021 Related pages updated to include ID 3986. General advice section in patient information updated to remove fertility and pregnancy/breastfeeding information. Version increased to V.7.
12/08/2022 Protocol reviewed by Medical Oncology Reference Committee. Nil changes. Next review in 4 years.

Version 6

Date Summary of changes
28/08/2009 Review, new dose modifications and transferred to eviQ.
02/07/2010 Haematological dose modifications updated (20% changed to 25% dose reduction).
18/02/2011 New format to allow for export of protocol information.
Protocol version number changed to V.2.
Antiemetics and premedications added to the treatment schedule.
Additional Clinical Information, Key Prescribing table and Key Administration table combined into new section titled "Clinical Considerations".
Drug specific information placed behind the drug name link.
30/06/2011 Protocol reviewed at reference committee meeting 20/05/11.
Title updated to specify the use of this protocol in the recurrent setting.
Indications updated to include "treatment of platinum resistant, recurrent ovarian, primary peritoneal or fallopian tube cancer".
Evidence updated to include a small phase III trial by Rosenburg et al which showed similar efficacy and lower toxicity with the weekly regimen. 
FAQ: Question on contraception removed as most patients would have had a hysterectomy or oopherectomy.
Premedication regimen reviewed and updated at reference committee meeting 20/05/11 (premedications the night before chemotherapy no longer included in this protocol).
21/10/2011 Premedications changed to PO as the default (may be substituted as per institutional guidelines or medical orders).
29/02/2012 PHC OMIS view added.
15/02/2013 Restrict paclitaxel volume to 250 mL as 500 mL not suitable for the majority of BSAs.
03/05/2013 Protocol reviewed at Medical Oncology Reference Committee meeting.
Reducing premedication included as default in treatment schedule
Next review in 1 year.
12/08/2014 PHC view removed.
24/06/2015 Reviewed electronically by Medical Oncology Reference Committee. No changes review 2 years.
31/05/2017 Transferred to new eviQ website. Protocol version number changed to V.4.
Hepatitis B screening changed to NOT recommended.
03/11/2017 Reviewed by Medical Oncology Reference Committee. No changes review 5 years.
10/05/2018 Haematological dose modifications updated as per consensus of the expert clinician group. Version number changed to V.5.
06/12/2018 Paclitaxel diluent changed from glucose 5% to sodium chloride 0.9%. Version change to V.6.
13/12/2019 Premedication added to administration discharge information section.
17/04/2020 "Ranitidine recall" flag added.

The information contained in this protocol is based on the highest level of available evidence and consensus of the eviQ reference committee regarding their views of currently accepted approaches to treatment. Any clinician (medical oncologist, haematologist, radiation oncologist, medical physicist, radiation therapist, pharmacist or nurse) seeking to apply or consult this protocol is expected to use independent clinical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. While eviQ endeavours to link to reliable sources that provide accurate information, eviQ and the Cancer Institute NSW do not endorse or accept responsibility for the accuracy, currency, reliability or correctness of the content of linked external information sources. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au

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The currency of this information is guaranteed only up until the date of printing, for any updates please check:

https://www.eviq.org.au/p/255

24 Jun 2025