The Evolving Role of Paclitaxel in Breast Cancer and the Ambulatory Care Setting

Not since the introduction of doxorubicin has a drug been as exciting and promising as paclitaxel for the treatment of breast cancer. Currently, the only approved use of paclitaxel in breast cancer is the metastatic setting. Paclitaxel is being studied in the adjuvant setting to assess its relative efficacy and to theoretically increase the chances of killing all micrometastases with alternate therapy with a different mechanism of cytotoxic activity. The optimal dose and schedule of administration have not been identified. Toxicities differ depending on dose and schedule, and treatment and prevention strategies for these toxicities are discussed. Continuous infusion administration can be accomplished with the use of ambulatory infusion devices. Issues of central venous access, use of premedications, use of granulocyte colony-stimulating factor (G-CSF), and dosages and schedule of paclitaxel will be discussed in relation to ambulatory paclitaxel administration. Special circumstances that require inpatient administration or special monitoring are also discussed.