Introduction: The classical taxanes (paclitaxel, docetaxel),
the newer taxane cabazitaxel and the nanoparticle-bound nab-paclitaxel
are among the most widely used anticancer drugs. Despite years of
research, the optimal dosing regimen (weekly versus 3-weekly) and
optimal dose are still controversial, as is the value of pharmacological
personalization of taxane dosing.
Areas covered: We give an overview on the pharmacological
properties of the taxanes, including metabolism,
pharmacokinetics-pharmacodynamic relations and aspects in the clinical
use of taxanes. The latter includes the ongoing debate on the most
effective and safe regimen (paclitaxel, docetaxel, nab-paclitaxel), the
recommended initial dose (cabazitaxel), and pharmacological dosing
individualization.
Expert opinion: The taxanes share the characteristics of
extensive hepatic metabolism and biliary excretion, the need for dose
adaptation in patients with liver dysfunction, and a substantial
pharmacokinetic variability even after taking into account known patient
chareacteristics. Data from clinical studies suggest that optimal
scheduling of the taxanes is dependent not only on the specific taxane
compound, but also on the tumor type and line of treatment. Finally,
treating oncologists should be aware of the substantial risk for
drug-drug interactions that is a direct consequence of the complex
hepatic metabolism of the taxanes.