BC Cancer Protocol Summary for Alternative Treatment of

Gynecological Malignancies using CARBOplatin and PACLitaxel NAB

(ABRAXANE)

Protocol Code GOCABR

Tumour Group Gynecologic Oncology

Contact Physician GO Systemic Therapy

ELIGIBILITY:

Patients must have:

 Previous severe hypersensitivity reaction or anaphylaxis to PACLitaxel that is not
manageable despite use of premedications, or
 Previous moderate PACLitaxel hypersensitivity reaction that cannot be managed by
premedications due to a strong contraindication to high dose steroids, such as poorly
controlled diabetes, and
 Been treated with and eligible for the following protocols:
 GOOVCATM, GOOVCATR, GOOVCATX, GOOVDDCAT
 GOCXCAT, UGOCXCATP
 GOENDAJCAT, GOENDAVCAT

EXCLUSIONS:
Patients must not have:
 Platinum resistant/refractory disease
 Disease progression on prior taxane therapy
 Severe hepatic dysfunction contraindicating PACLitaxel NAB

CAUTION:
 Greater than or equal to grade 2 sensory or motor neuropathy

TESTS:
 Baseline: CBC & Diff, creatinine, total bilirubin, ALT
 Baseline, if clinically indicated: CA 125, CA 15-3, CA 19-9, CEA, SCC
 Day 14 (and Day 21 if using a 4 week cycle interval) of first cycle (optional, if not done with
prior regimen) and subsequent cycles if a dose modification has been made: CBC & diff,
platelets. No need for interim count check once safe nadir pattern has been established.
 Before each treatment: CBC & Diff, creatinine
 If clinically indicated: total bilirubin, alkaline phosphatase, GGT, ALT, CA 125, CA 15-3,
CA 19-9, CEA, SCC

BC Cancer Protocol Summary GOCABR Page 1 of 5

Activated: 1 Sep 2020 Revised: 1 Jun 2025 (Eligibility and contact info updated)
Warning: The information contained in these documents are a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to
apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at
your own risk and is subject to BC Cancer's terms of use available at www.bccancer.bc.ca/terms-of-use.
PREMEDICATIONS:
 Antiemetic protocol for highly emetogenic chemotherapy (see protocol SCNAUSEA)

TREATMENT:

Drug Dose BC Cancer Administration Guideline

PACLitaxel NAB 260 mg/m² IV over 30 minutes*

(ABRAXANE)

CARBOplatin Dose = AUC** x (GFR +25) IV in 100 to 250 mL NS over 30

minutes

*in empty sterile bags and tubing with 15 micron filter; no specific material required for bag or
tubing

**use AUC of 6; if extensive prior radiation therapy, use AUC of 5

Repeat every 21 to 28 days to complete total number of cycles in original CARBOplatin and
PACLitaxel protocol.

Measured GFR (e.g. nuclear renogram) is preferred in circumstances of co-morbidity that could
affect renal function (third-space fluid accumulations, hypoproteinemia, potentially inadequate
fluid intake, age greater than 70, etc.). The lab reported GFR (MDRD formula) may be used as
an alternative to the Cockcroft-Gault estimate of GFR; the estimated GFR reported by the lab or
calculated using the Cockcroft-Gault equation should be capped at 125 mL/min when it is used
to calculate the initial carboplatin dose. When a nuclear renogram is available, this clearance
would take precedence.

Cockcroft-Gault Formula

1.04 x (140 - age in years) x wt (kg)

GFR =
serum creatinine (micromol/L)

Recalculate GFR if creatinine increases by greater than 20% or rises above the upper limit of
normal.

BC Cancer Protocol Summary GOCABR Page 2 of 5

Activated: 1 Sep 2020 Revised: 1 Jun 2025 (Eligibility and contact info updated)
Warning: The information contained in these documents are a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to
apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at
your own risk and is subject to BC Cancer's terms of use available at www.bccancer.bc.ca/terms-of-use.
DOSE MODIFICATIONS:
1. Hematological

a) on treatment day:
ANC (x 109/L) Platelets (x 109/L) Doses (both drugs)

greater than or equal to 1.5 and greater than or equal to 100 treat as per nadir (if applicable);
otherwise, proceed at same doses

less than 1.5 or less than 100 Delay until recovery. If using 21-day
interval, switch to 28-day interval. If
2nd delay, use filgrastim (G-CSF) or
dose reduction.

b) at nadir (until nadir pattern established):

ANC (x 109/L) Platelets (x 109/L) PACLitaxel NAB* CARBOplatin*

greater than or equal to 0.5 and greater than or equal to 75 100% 100%

less than 0.5 and less than 75 80% 80%

less than 0.5 and greater than or equal to 75 80% 100%

greater than or equal to 0.5 and less than 75 100% 80%

febrile neutropenia at any time 80% 80%

* % of previous cycle’s dose, at physician’s discretion. If dose is changed, subsequent nadir counts
must be checked.
Note: If dose has been reduced, dose increase/re-escalation for good nadir counts is not
recommended.

2. Sensory Neuropathy: PACLitaxel NAB

Grade Toxicity Dose – 1st Occurrence Dose – 2nd Occurrence

1 Asymptomatic; loss of deep tendon Maintain dose Maintain dose
reflexes or paresthesia (including
tingling) but not interfering with
function
2 Sensory alteration or paresthesia Maintain dose Maintain dose
(including tingling) but not interfering
with function, but not interfering with
ADL
3 Sensory alteration or paresthesia Hold treatment until Hold treatment until
interfering with ADL resolved to grade 2, then resolved to grade 2, then
reduce dose to 70%** reduce dose to 85%**
4 Disabling Hold treatment until Hold treatment until
resolved to grade 2, then resolved to grade 2, then
reduce dose to 70%** or reduce dose to 85%**
discontinue further therapy
** Dose reductions should be maintained for subsequent cycles and not re-escalated.

BC Cancer Protocol Summary GOCABR Page 3 of 5

Activated: 1 Sep 2020 Revised: 1 Jun 2025 (Eligibility and contact info updated)
Warning: The information contained in these documents are a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to
apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at
your own risk and is subject to BC Cancer's terms of use available at www.bccancer.bc.ca/terms-of-use.
3. Hepatic dysfunction: PACLitaxel NAB

ALT or AST Bilirubin PACLitaxel NAB

Greater than 1 to less than or

Less than or equal to 10 x ULN and 100%
equal to 1.5 x ULN

Greater than 1.5 to less than

Less than or equal to 10 x ULN and/or 80%*
or equal to 5 x ULN

Greater than 10 x ULN or Greater than 5 x ULN Hold

*may re-escalate dose if hepatic function normalizes and reduced dose is tolerated for at least 2 cycles

4. Arthralgia and/or myalgia: If arthralgia and/or myalgia of grade 2 (moderate) or higher is

not relieved by adequate doses of NSAIDs or acetaminophen with codeine (e.g., TYLENOL
#3®), a limited number of studies report a possible therapeutic benefit using:
 predniSONE 10 mg PO bid x 5 days starting 24 hours post-PACLitaxel NAB
 gabapentin 300 mg PO on day before chemotherapy, 300 mg bid on treatment day, then
300 mg tid x 5-15 days (based on duration of arthromyalgia)
If arthralgia and/or myalgia persist, reduce subsequent PACLitaxel NAB doses to 85%

5. Renal dysfunction: If significant increase (greater than 20% or rises above the upper limit
of normal) in creatinine, recheck/recalculate GFR and recalculate CARBOplatin dose using
new GFR. No modification is required for PACLitaxel NAB in mild to moderate renal
impairment. PACLitaxel NAB has not been studied in patients with creatinine clearance less
than 30 mL/min.

PRECAUTIONS:
1. An albumin form of PACLitaxel may substantially affect a drug’s functional properties relative
to those of drug in solution. Do not substitute with or for other PACLitaxel formulations.
2. Neutropenia: Fever or other evidence of infection must be assessed promptly and treated
aggressively. Refer to BC Cancer Febrile Neutropenia Guidelines.
3. Extravasation: PACLitaxel NAB causes pain and may, rarely, cause tissue necrosis if
extravasated. Refer to BC Cancer Extravasation Guidelines.
4. Hypersensitivity: Reactions to CARBOplatin may occur. Refer to BC Cancer SCDRUGRX
protocol.
5. Drug interactions: PACLitaxel NAB is metabolized by CYP2C8 and CYP3A4; caution
should be exercised when administering with drugs which are CYP2C8 or CYP3A4 inducers
or inhibitors.
6. Cardiac toxicity has been reported rarely while patients receive PACLitaxel NAB. Severe
cardiovascular events (3%), including chest pain, cardiac arrest, supraventricular
tachycardia, edema, thrombosis, pulmonary thromboembolism, pulmonary emboli, and
hypertension.
7. Theoretical risk of viral disease transmission, due to human albumin component, is
extremely remote.

BC Cancer Protocol Summary GOCABR Page 4 of 5

Activated: 1 Sep 2020 Revised: 1 Jun 2025 (Eligibility and contact info updated)
Warning: The information contained in these documents are a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to
apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at
your own risk and is subject to BC Cancer's terms of use available at www.bccancer.bc.ca/terms-of-use.
Contact the GO Systemic Therapy physician at your regional cancer centre or GO
Systemic Therapy Chair with any problems or questions regarding this treatment
program.

References:
1. Alberts DS, Blessing JA, Landrum LM, et al. Phase II trial of nab-paclitaxel in the treatment of
recurrent or persistent advanced cervix cancer: a gynecologic oncology group study. Gynecol
Oncol. 2012 Dec;127(3): 451-5.
2. Srinivasan KN, Rauthan A, Gopal R. Combination therapy of albumin-bound paclitaxel and
carboplatin as first line therapy in a patient with ovarian cancer. Case Rep Oncol Med [Internet].
2014 [cited 23 Jul 2020]. Available from: https://doi.org/10.1155/2014/940591
3. Parisi A, Palluzzi E, Cortellini A, et al. First-line carboplatin/nab-paclitaxel in advanced
ovarian cancer patients, after hypersensitivity reaction to solvent-based taxanes: a single-
institution experience. Clin Transl Oncol. 2020;22:158-62.
4. Maurer K, Michener C, Mahdi H, Rose PG. Universal tolerance of nab-paclitaxel for
gynecologic malignancies in patients with prior taxane hypersensitivity reactions. J Gynecol
Oncol. 2017 Jul;28(4):e38
5. Pellegrino B, Boggiani D, Tommasi C, et al. Nab-paclitaxel after docetaxel hypersensitivity
reaction: case report and literature review. Acta Biomed. 2017;88(3):329-33.
6. Dizon DS, Schwartz J, Rojan A, et al. Cross-sensitivity between paclitaxel and docetaxel in a
women’s cancers program. Gyencol Oncol. 2006;100:149-51.
7. Sanchez-Munoz A, Jimenez B, Garcia-Tapiador A. Cross-sensitivity between taxanes in
patients with breast cancer. Clin Transl Oncol. 2011;13:904-6.
8. Celgene Inc. ABRAXANE® product monograph. Mississauga, Ontario; 31 August 2018

BC Cancer Protocol Summary GOCABR Page 5 of 5

Activated: 1 Sep 2020 Revised: 1 Jun 2025 (Eligibility and contact info updated)
Warning: The information contained in these documents are a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to
apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at
your own risk and is subject to BC Cancer's terms of use available at www.bccancer.bc.ca/terms-of-use.