This information is about a chemotherapy treatment called paclitaxel and carboplatin, which is used to treat cancer of the ovary and cancer of the lung. Paclitaxel may also be called Taxol, so this chemotherapy regime is sometimes known as TaxolCarbo. This information describes the drugs, how they are given and some of the possible effects. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

The treatment involves the two chemotherapy drugs paclitaxel, which is commonly known as Taxol, and carboplatin.

Your chemotherapy treatment will be given to you as a day patient, or occasionally you may need to stay in hospital overnight. You will need a blood test before you start treatment – either on the same day, or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.

The nurse will then put a thin tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful but it should not take long. Some people have their chemotherapy given through a thin plastic tube which is inserted under the skin into a vein near the collarbone (central line), or passed through a vein in their arm (PICC line). Your doctor or nurse will explain more about this to you.

You will be given anti-sickness (anti‑emetic) drugs, usually by injection through the cannula, your central or PICC line, although some anti-sickness drugs can be given as tablets. You will also be given medicines to prevent the allergic reaction that some people have when given paclitaxel. This anti-allergy medicine is often given by injection, but part of it is sometimes given as tablets to take at home before coming to the hospital. It is very important to take the tablets and you must tell your doctor or nurse if, for any reason, you have not taken them.

The chemotherapy drugs are then given separately:

• you will be given Taxol (a colourless fluid) as a drip (infusion) over about three hours
• after this you will be given carboplatin (a colourless fluid), as a drip over about one hour.

The whole treatment takes up to 4–5 hours.

If you are having your treatment as a day patient you can then go home. The cannula will be removed and you will be given a supply of anti-sickness drugs to take with you. You should take these regularly if you have been told to do so, even if you are not feeling sick. This is because some medicines are much more effective at preventing sickness than stopping it once it has started.

Your doctor may use the word 'regimen' (eg the TaxolCarbo regimen) when talking about your chemotherapy. This means the whole plan or schedule of the treatment that you are receiving.

When your treatment begins you will be given Taxol and carboplatin (as described) for one day only. After this you will have a rest period with no chemotherapy for the next three weeks. This completes what is called a cycle of your treatment.

After the rest period the same treatment is repeated, which begins the next cycle of your chemotherapy. Usually 6–8 cycles are given over a period of 5–6 months. This makes up a course of treatment.

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described below will not affect everyone who is having treatment with paclitaxel and carboplatin. We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you notice any effects that you think may be due to the drug, but which are not listed here, please let your nurse or doctor know.

Lowered resistance to infection This treatment can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, with your resistance to infection usually reaching its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.

Bruising or bleeding Taxol and carboplatin chemotherapy can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding.

Anaemia (low number of red blood cells) While having this treatment you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these effects are a problem.

Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. If the sickness is not controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness drugs which may be more effective. Some anti-sickness drugs may cause constipation. Let your doctor or nurse know if this is a problem.

Tiredness Many people feel extremely tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it is important to try to get as much rest as you need.

Hair loss This usually starts 3–4 weeks after the first course of treatment and is due to paclitaxel. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will start to regrow once the treatment has finished.

Scalp cooling is a method of reducing hair loss that may be helpful for some people. You can ask your doctor or nurse if it is available at your hospital.

Sore mouth and ulcers Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Tell your nurse or doctor if you have any of these problems, as they can give you special mouthwashes and medicine to prevent or clear any mouth infection. Using a soft toothbrush may be helpful.

Taste changes You may notice that your food tastes different. Normal taste will come back after the treatment finishes.

Diarrhoea This may occur several days after the treatment. Diarrhoea can usually be easily controlled with medicine. Let your doctor know if it is severe or if it continues. Try to drink as much as 2–3 litres of liquid a day to replace the fluid you are losing.

Numbness or tingling in hands or feet This is due to the effect of paclitaxel or carboplatin on nerves and is known as peripheral neuropathy. Tell your doctor if you notice these effects. The problem usually improves slowly a few months after treatment is over.

Aching joints and muscles You may have these symptoms a few days after treatment (due to the Taxol). This does not usually last long and your doctor can prescribe mild painkillers to help.

Headaches Some people find that paclitaxel causes headaches. Let your doctor know if this happens to you.

Your kidneys may be affected This is a rare side effect and unlikely to cause any symptoms. The function of your kidneys may be checked by a blood test before each treatment. Sometimes a 24-hour urine test is also carried out.

Allergic reaction Some people can have an allergic reaction to the chemotherapy. Signs of this can include skin rashes and itching, a high temperature, shivering, dizziness, a headache and breathlessness. You will be given medicine (a steroid) before treatment to reduce the chance of this happening. It is important to take the steroids as you have been directed. Let your nurse or doctor know if you have any of these symptoms, as they can quickly be treated.

Always let your doctor or nurse know about any side effects that you have. There are usually ways in which they can be controlled or improved.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs which thin the blood. Your doctor or nurse can give you more information. 

Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Always tell your doctor about any medicine that you are taking.

Fertility Your ability to become pregnant or father a child may be affected by this treatment. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking this treatment, as the developing foetus may be harmed. It is important to use effective contraception while taking these drugs, and for at least a few months afterwards. Again, discuss this with your doctor.

Loss of periods in women Due to the effect of chemotherapy on the ovaries you may find that your periods become irregular and may eventually stop. In some women this may be temporary, but for others it may be permanent. If your periods stop permanently this will result in menopausal symptoms such as hot flushes and sweats.

This section is based upon our paclitaxel and carboplatin chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott, Williams and Wilkins, 2001.

For further references, please see the general bibliography.