Paclitaxel

Overview

Paclitaxel, an alkaloid derived from the Pacific yew, and sold under the brand name Taxol among others, is a chemotherapy medication used to treat ovarian cancer, esophageal cancer, breast cancer, lung cancer, Kaposi's sarcoma, cervical cancer, and pancreatic cancer. It is administered by intravenous injection. There is also an albumin-bound formulation.[1] WP

Common side effects include hair loss, bone marrow suppression, numbness, allergic reactions, muscle pains, and diarrhea. Other side effects include heart problems, increased risk of infection, and lung inflammation. There are concerns that use during pregnancy may cause birth defects. Paclitaxel is in the taxane family of medications. It works by interference with the normal function of microtubules during cell division.[1][2][3] WP

Paclitaxel was isolated in 1971 from the Pacific yew and approved for medical use in 1993. It is on the World Health Organization's List of Essential Medicines. It has been made from precursors, and through cell culture.[4][5][6] WP

Uses, dosage and effects

Medical use

Paclitaxel is approved in the UK for ovarian, breast, lung, bladder, prostate, melanoma, esophageal, and other types of solid tumor cancers as well as Kaposi's sarcoma.[7] WP

It is recommended in National Institute for Health and Care Excellence (NICE) guidance of June 2001 for non-small-cell lung cancer in patients unsuitable for curative treatment, and in first-line and second-line treatment of ovarian cancer. In September 2001, NICE recommended paclitaxel for the treatment of advanced breast cancer after the failure of anthracyclic chemotherapy, but that its first-line use should be limited to clinical trials. In September 2006, NICE recommended paclitaxel should not be used in the adjuvant treatment of early node-positive breast cancer.[8] WP

It is approved in the United States for the treatment of breast, pancreatic, ovarian, Kaposi's sarcoma and non-small-cell lung cancers.[9] WP

Similar compounds

Albumin-bound paclitaxel (brand name Abraxane, also called nab-paclitaxel) is an alternative formulation where paclitaxel is bound to albumin nanoparticles. Much of the clinical toxicity of paclitaxel is associated with the solvent Cremophor EL in which it is dissolved for delivery.[10] WP

Abraxis BioScience developed Abraxane, in which paclitaxel is bonded to albumin as an alternative delivery agent to the often toxic solvent delivery method. This was approved by the FDA in January 2005, for the treatment of breast cancer after failure of combination chemotherapy for metastatic disease or relapse within six months of adjuvant chemotherapy. It has since been approved for locally advanced or metastatic non-small cell lung cancer and metastatic adenocarcinoma of the pancreas as well.[11][12] WP

Taxanes, including paclitaxel, 10-deacetylbaccatin III, baccatin III, paclitaxel C, and 7-epipaclitaxel, have been found in the leaves and shells of hazel. The finding of these compounds in shells, which are considered discarded material and are mass-produced by many food industries, is of interest for the future availability of paclitaxel.[13][14] WP

Restenosis

Paclitaxel is used as an antiproliferative agent for the prevention of restenosis (recurrent narrowing) of coronary and peripheral stents; locally delivered to the wall of the artery, a paclitaxel coating limits the growth of neointima (scar tissue) within stents. Paclitaxel drug-eluting stents for coronary artery placement are sold under the trade name Taxus by Boston Scientific in the United States. Paclitaxel drug-eluting stents for femoropopliteal artery placement are also available.[15] WP⚠ Wikipedia itself has flagged this text: citation needed.

Risks and side effects

Side effects

Common side effects include nausea and vomiting, loss of appetite, change in taste, thin or brittle hair, pain in the joints of the arms or legs lasting two to three days, changes in the color of the nails, and tingling in the hands or toes. More serious side effects such as unusual bruising or bleeding, pain, redness or swelling at the injection site, hand-foot syndrome, change in normal bowel habits for more than two days, fever, chills, cough, sore throat, difficulty swallowing, dizziness, shortness of breath, severe exhaustion, skin rash, facial flushing, female infertility by ovarian damage, and chest pain can also occur. Neuropathy may also occur.[1][16] WP

Dexamethasone is given prior to paclitaxel infusion to mitigate some of the side effects.[17] WP

A number of these side effects are associated with the excipient used, Cremophor EL, a polyoxyethylated castor oil. Allergies to cyclosporine, teniposide, and other drugs delivered in polyoxyethylated castor oil may increase the risk of adverse reactions to paclitaxel.[18] WP

Pharmacology

Mechanism of action

Paclitaxel is one of several cytoskeletal drugs that target tubulin. Paclitaxel-treated cells have defects in mitotic spindle assembly, chromosome segregation, and cell division. Unlike other tubulin-targeting drugs, such as colchicine, that inhibit microtubule assembly, paclitaxel stabilizes the microtubule polymer and protects it from disassembly. Chromosomes are thus unable to achieve a metaphase spindle configuration. This blocks the progression of mitosis and prolonged activation of the mitotic checkpoint triggers apoptosis or reversion to the G0-phase of the cell cycle without cell division.[19][20] WP

The ability of paclitaxel to inhibit spindle function is generally attributed to its suppression of microtubule dynamics, but other studies have demonstrated that suppression of dynamics occurs at concentrations lower than those needed to block mitosis. At the higher therapeutic concentrations, paclitaxel appears to suppress microtubule detachment from centrosomes, a process normally activated during mitosis. Paclitaxel binds to the beta-tubulin subunits of microtubules.[21][22][23] WP

Research

Research

Caffeine has been speculated to inhibit paclitaxel-induced apoptosis in colorectal cancer cells.[24] WP

In 2016, in vitro multi-drug resistant mouse tumor cells were treated with paclitaxel encased in exosomes. Doses 98% less than common dosing had the same effect. Also, dye-marked exosomes were able to mark tumor cells, potentially aiding in diagnosis.[25][26] WP

Aside from its direct clinical use, paclitaxel is also used extensively in biological and biomedical research as a microtubule stabilizer. In general, in vitro assays involving microtubules, such as motility assays, rely on paclitaxel to maintain microtubule integrity in the absence of the various nucleating factors and other stabilizing elements found in the cell. For example, it is used for in vitro tests of drugs that aim to alter the behavior of microtubule motor proteins, or for studies of mutant motor proteins. WP⚠ A word may be missing here. It reads this way in the source too.

Paclitaxel has also been used in vitro to inhibit insulin fibrillation. In a molar ratio of 10:1 (insulin:paclitaxel), it hindered insulin fibrillation near 70%. Isothermal titration calorimetry (ITC) findings indicated a spontaneous tendency of paclitaxel to interact with insulin through hydrogen bonds and van der Waals forces. The inhibitory role of paclitaxel is attributed to its impact on the colloidal stability of protein solution, as it was observed that paclitaxel inhibited lysozyme fibrillation by inducing the formation of "off-pathway" oligomeric intermediates, subsequently increasing the colloidal stability.[27][28] WP

Paclitaxel is sometimes used for in vivo studies as well. It can be fed to test organisms, such as fruit flies, or injected into individual cells, to inhibit microtubule disassembly or to increase the number of microtubules in the cell. Paclitaxel induces remyelination in a demyelinating mouse in vivo and inhibits human peptidylarginine deiminase 2 (hPAD2) in vitro though its methyl ester side chain. In 1999, Angiotech Pharmaceuticals Inc. began phase II clinical trials of micellar paclitaxel as treatment for secondary progressive multiple sclerosis, but reported in 2002 that the results showed no statistical significance.[29–32] WP⚠ A word may be missing here. It reads this way in the source too.

Legal status

Legal status

Paclitaxel was approved for medical use in the European Union in 2008.[33] WP

In November 2023, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Naveruclif, intended for the treatment of metastatic breast cancer, metastatic adenocarcinoma of the pancreas and non-small cell lung cancer. The applicant for this medicinal product is Accord Healthcare S.L.U. Naveruclif was approved for medical use in the European Union in January 2024.[33][34] WP

In May 2024, the CHMP adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Apexelsin, intended for the treatment of metastatic breast cancer, metastatic adenocarcinoma of the pancreas and non-small cell lung cancer. The applicant for this medicinal product is WhiteOak Pharmaceutical B.V. Apexelsin was approved for medical use in the European Union in July 2024.[35][36] WP

Economics

As of 2006, the cost to the NHS per patient in early breast cancer, assuming four cycles of treatment, was about £4,000 (approx. $6,000).[37] WP

Chemistry

Formula

C47H51NO14 PC

CAS number

33069-62-4 PC

Molar mass (g/mol)

853.9 PC

IUPAC name (computed by PubChem)

[(1S,2S,3R,4S,7R,9S,10S,12R,15S)-4,12-diacetyloxy-15-[(2R,3S)-3-benzamido-2-hydroxy-3-phenylpropanoyl]oxy-1,9-dihydroxy-10,14,17,17-tetramethyl-11-oxo-6-oxatetracyclo[11.3.1.03,10.04,7]heptadec-13-en-2-yl] benzoate PC

SMILES

CC1=C2[C@H](C(=O)[C@@]3([C@H](C[C@@H]4[C@]([C@H]3[C@@H]([C@@](C2(C)C)(C[C@@H]1OC(=O)[C@@H]([C@H](C5=CC=CC=C5)NC(=O)C6=CC=CC=C6)O)O)OC(=O)C7=CC=CC=C7)(CO4)OC(=O)C)O)C)OC(=O)C PC

InChIKey

RCINICONZNJXQF-MZXODVADSA-N PC

PubChem CID

36314

Harm reduction information

No harm reduction data is on file for this compound yet. That means no dose, timing or combination data from PsychonautWiki or TripSit. Please don't guess a dose from similar compounds. If you have taken it and feel unwell, contact emergency services or a poison control center.

User reports

Pop culture

No references added yet.

Sources

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8. Other British National Formulary
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11. Journal / agency Drug Approval Package: Abraxane (Pcalitaxel Protein-Bound Particles) NDA #021660
12. Journal / agency Abraxane- paclitaxel injection, powder, lyophilized, for suspension. 31 October 2022
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20. Journal / agency Brito DA, Yang Z, Rieder CL. Microtubules do not promote mitotic slippage when the spindle assembly checkpoint cannot be satisfied. The Journal of Cell Biology. August 2008. doi:10.1083/jcb.200805072 · PMID 18710927 · PMC2518701
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22. Journal / agency Ganguly A, Yang H, Cabral F. Paclitaxel-dependent cell lines reveal a novel drug activity. Molecular Cancer Therapeutics. November 2010. doi:10.1158/1535-7163.MCT-10-0552 · PMID 20978163 · PMC2978777
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25. Other Lavars N. Cloaking chemo drugs in cellular bubbles destroys cancer with one fiftieth of a regular dose. 14 January 2016
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28. Journal / agency Kachooei E, Mozaffarian F, Khodagholi F, Sadeghi P, Karami L, Ghasemi A, Vahdat E, Saboury AA, Sheibani N, Moosavi-Movahedi AA. Paclitaxel inhibited lysozyme fibrillation by increasing colloidal stability through formation of "off-pathway" oligomers. International Journal of Biological Macromolecules. May 2018. doi:10.1016/j.ijbiomac.2018.01.072 · PMID 29352977
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34. Other Naveruclif PI. 8 January 2024
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36. Other Apexelsin PI. 26 July 2024
37. Other NICE Guidance TA108. 27 September 2006

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