A 44-year-old woman diagnosed with invasive lobular breast carcinoma stage IV (bone and liver metastases), was prescribed second line chemotherapy with the scheme carboplatin AUC-2 and paclitaxel 80 mg/m2 days 1, 8 and 15 every 21 days. Baseline total serum bilirubin was 6.9 mg/dL (normal range 0.2-1.2 mg/dL) and direct bilirubin 5.9 mg/dL (normal range <0.6 mg/dL), so paclitaxel dose was reduced to 50%. Seven doses of chemotherapy were administered and total bilirubin levels decreased down to 1 mg/dL. As previous studies suggest, reducing paclitaxel dose to 50% appears to be safe in patients with hyperbilirubinemia due to hepatic tumor involvement
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