Nab-Paclitaxel: Uses, Dosage, and Side Effects

What Is Nab-Paclitaxel?

Nab-Paclitaxel is a variant of the chemotherapy drug Paclitaxel. As a chemotherapy agent, this can damage and destroy cancer cells, preventing their spread. This medicine can treat breast cancer, non-small cell lung cancer, or pancreatic cancer. Specifically, it can treat highly aggressive cancers that spread rapidly.

This particular variant is enriched with nanoparticles and binds with our albumin. These modifications from the parent drug increase efficiency and reduce medicine-related complications.

Is Nab-Paclitaxel FDA Approved?

Paclitaxel got its approval in 2005 from the Food and Drug Administration (FDA). However, in 2024, the single-dose protein-bound particles (albumin-bound) variant for intravenous use known as Nab-Paclitaxel got its approval.

How Does Nab-Paclitaxel Work?

Scientists have developed Paclitaxel from the bark of the yew tree (Taxus brevifolia). Doctors use it to treat solid tumors. As this medicine does not dissolve in water, scientists used solvents such as castor oil or ethanol to dilute it. However, this injection has been used to cause several health issues like allergy, skin rashes, hypersensitivity reactions, or nerve damage.

Mechanism of Action:

• Scientists have recently developed a nanoparticle-enriched, albumin-bound form of Paclitaxel. This form does not need any solvent.
• Patients experience less irritation during injection. Not only that, albumin-bound Paclitaxel can identify and target cancer cells via the albumin-receptor-mediated pathway.
• Nab-Paclitaxel belongs to the taxane group of drugs.
• These medicines attack the microtubules of cancer cells. These microtubules are nothing but the skeletons of cells. As the skeletons of the cells are attacked, this disrupts the normal functioning of the cells. This disrupts the cell cycle and prevents cancer cells from dividing. As a result, this medicine prevents the growth and spread of cancer.

Which Conditions Does Nab-Paclitaxel Treat?

• If the chemotherapy cannot prevent the growth and the spread of breast cancer even after six months of treatment. In such cases, it is used.
• If the patient has a locally advanced non-small cell lung cancer, the doctor can use it with Carboplatin as a first line of treatment. This is also effective for patients for whom doctors cannot perform surgery or give radiation therapy.
• Gemcitabine is combined with Nab-Paclitaxel as a first-line treatment option for advanced and aggressive adenocarcinoma of the pancreas.

What Is the Dosage and Treatment Schedules of Nab-Paclitaxel?

Doctors give Nab-Paclitaxel based on the patient's body surface area (square meter or m2). They measure your weight and height, and measure your body surface area based on those. Patients always receive this medicine under the supervision of the doctor and health care provider via intravenous infusion. This drip can only be given in a hospital setup through

• Via a cannula, which delivers the drug to the vein.
• A central line, which is a hollow tube connected to a vein in the chest.
• A PICC (peripherally inserted central catheter) delivers directly to your heart via a large vein.

Dosage:

For different cancer cases, doctors prefer different dosages. These are:

1. If the patient has metastatic breast cancer, the dose of Nab-Paclitaxel is 260 milligrams (mg)/ m2. The drip is given for 30 minutes every three weeks.
2. If the patient has metastatic adenocarcinoma, the Nab-Paclitaxel dosage schedule is 125 mg/m2. The drip takes 30 minutes to transfuse the medicine into the patient’s body. It is combined with Gemcitabine and given on the 1st, 8th, 15th, and 28th day of the cycle.
3. For non-small cell lung cancer, the dose of Nab-Paclitaxel is 100 mg/m2. The intravenous drip is given on the first, eighth, fifteenth, and twenty-first day of the cycle. On the 1st and 21st day of the cycle, doctors combine Nab-Paclitaxel with Carboplatin.

Treatment Schedules:

However, doctors assess patients' conditions before prescribing it. The following physical conditions of the patients may need dose modifications:

1. Doctors assess patients' white blood cell and platelet counts before a Nab-Paclitaxel drip. A patient needs a minimum neutrophil count of 1500 cells per cubic millimeter (cells/mm3) and a platelet count of 100,000 cells/mm3 for Nab-Paclitaxel therapy. A lower blood cell count is not suitable for this chemotherapy infusion.
2. If the patient has nerve issues affecting the hand, feet, and other parts of the body, a lower dose of Carboplatin and Nab-Paclitaxel is appropriate.
3. If the patient has issues such as diarrhea or digestive tract ulceration, the doctor can give a lower dose of Nab-Paclitaxel.
4. In our liver, cytochrome P450 helps metabolize Nab-Paclitaxel. Medicines such as Erythromycin, Clopidogrel, Cimetidine, Ritonavir, Saquinavir, Indinavir, and Ketoconazole can impair the function of these enzymes. As a result, patients can experience severe toxic effects of Nab-Paclitaxel due to its accumulation in the body.

What Are the Side Effects of Nab-Paclitaxel?

A. Common Side Effects:

1. Effects on Blood Cells:

Nab-Paclitaxel can affect the patient's bone marrow. This can lead to issues like:

• Low red cells leading to anemia.
• Reduced white blood cells, specifically neutrophils and leucocytes.
• Thrombocytopenia which is caused by a lower number of platelets.

2. Effects on Heart:

Nab-Paclitaxel can lead to several heart issues.

• An abnormal heartbeat can cause a lower or a higher heart rate (bradycardia or tachycardia).
• A drop in blood pressure.
• Sudden chest pain due to cardiac arrest.

3. Effects on Digestive System:

• Anorexia can cause loss of appetite.
• Diarrhea.
• Abdominal pain due to gastrointestinal ulcers.
• Severe nausea and vomiting.
• Liver problems can lead to an abnormal level of liver enzymes.

Other common side effects of Nab-Paclitaxel include;

• Fever.
• Body ache and muscle pain.
• Generalized weakness.
• Skin rashes, itching, and burning sensations due to hypersensitivity reactions.
• Abnormal sensations or lack of sensation in various parts of the body due to nerve damage.
• Loss of immunity can cause lung infections, cough, and chest pain.
• Hair loss.

B. Risks:

• It causes birth defects in the unborn child. As a result, pregnant women should not take it.
• Breastfeeding mothers should not take this medicine as it can be passed on to the baby via breast milk and damage the baby.
• It hampers the fertility capacity of both males and females.
• As Nab-Paclitaxel can cause severe birth defects in children, men, and women should use contraception while taking this medicine. Also, men should continue to use contraception at least three months after the last dose of Nab-Paclitaxel. Women should continue to use contraception at least for six months after the last dose of Nab-Paclitaxel.
• If the patient is experiencing severe blood loss, treatment should be stopped immediately. This can happen due to severe bone marrow suppression.
• A drop in immunity can cause severe lung infections. This may lead to sepsis.
• In patients over 75 years old, it can cause severe side effects.

When to Seek Help?

If a patient taking Nab-Paclitaxel experiences the following issues, they must seek immediate help.

• Severe vomiting, diarrhea, and blood in the poop.
• Severe chest pain and difficulty in breathing.
• Symptoms such as nosebleeds, large bruises, or tiny red dots on the skin.
• Breathing issues along with a severe cough.
• Severe skin rash and exfoliation on the skin.
• Extreme fatigue, weakness, fever, and chills.

Conclusion

Nab-Paclitaxel belongs to the taxane group of drugs. This nanoparticle-enriched, albumin-bound form of Paclitaxel is known for better efficacy and fewer side effects. Doctors use Nab-Paclitaxel drips for the treatment of breast cancer, lung cancer, and pancreatic cancer. This chemotherapy drug can prevent cancer growth by preventing its growth. If you have any queries, you can consult a cancer specialist for further evaluation.

Key Takeaways

• Nab-Paclitaxel is a chemotherapeutic medicine.
• It hampers the functionality of microtubules and disrupts the functionality of cancer cells.
• It is used in the case of breast cancer, non-small cell lung cancer, and pancreatic cancer.
• Nab-Paclitaxel drip can cause side effects like fever, chills, skin rashes, weakness, and vomiting.