An optically clear, pharmaceutically acceptable aqueous composition comprising paclitaxel or a derivative thereof, serum albumin and a pharmaceutically acceptable vehicle, wherein the composition comprises no more than 10% organic solvent and has a pH of about 3.0 to about 4.8, is described. The serum albumin can be fatted or defatted, and the composition can optionally be lyophilized or optionally lyophilized and reconstituted. At least 70% of the paclitaxel is bound to serum albumin, the ratio of paclitaxel to albumin is at least about 1:5, and the concentration of paclitaxel is at least about 25 μg/ml. Methods of making and using this composition an also provided.