BACKGROUND: Rotor's syndrome is a rare congenital disorder characterized by 
functional hyperbilirubinemia. Treatment decision may be challenging in a cancer 
patient with Rotor's syndrome, since the majority of the antineoplastic agents 
are metabolized in the liver and excreted via the biliary system. We report the 
first case of paclitaxel administration in a patient with ovarian cancer and 
elevated bilirubin levels due to Rotor's syndrome.
CASE: A 50-year-old woman with Rotor's syndrome had an exploratory laparotomy 
and was diagnosed to have stage IIIC epithelial ovarian cancer. The baseline 
serum bilirubin value was 15.3 mg/dL. She was started on a 50% dose of 87.5 
mg/m(2) paclitaxel by 3-h infusion plus carboplatin AUC-6. The paclitaxel dose 
was increased by 25% at consecutive cycles until the standard dose of 175 
mg/m(2)/3 h was achieved. Six cycles were administered without any metabolic 
derangement. The patient was rendered disease free with this treatment.
CONCLUSION: Paclitaxel appears to be safe to administer to cancer patients with 
functional hyperbilirubinemia.