Drug type: Docetaxel is an anti-cancer (“antineoplastic” or “cytotoxic”) chemotherapy drug. This medication is classified as a “plant alkaloid,” a “taxane” and an “antimicrotubule agent
Drug is Indicated
Approved in treatment of breast cancer, non-small cell lung cancer, advanced stomach cancer, head and neck cancer and metastatic prostate cancer. Also being investigated to treat small cell lung, ovarian, bladder, and pancreatic cancers, soft tissue sarcoma and melanoma.
How This Drug is Given
- Docetaxel is given through a vein (intravenously, IV)
- There is no pill form of docetaxel
- Premedication with a corticosteroid pill starting a day prior to docetaxel infusion for 3 days is given to reduce the severity of fluid retention and allergic reactions. Your doctor will prescribe the exact regimen.
- The amount of docetaxel that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated.
- Your doctor will determine your dose and schedule
Important things to remember about the side effects of docetaxel
- Most people do not experience all of the side effects listed
- Side effects are often predictable in terms of their onset and duration
- Side effects are almost always reversible and will go away after treatment is complete
- There are many options to help minimize or prevent side effects
- There is no relationship between the presence or severity of side effects and the effectiveness of the medication.
- The side effects of docetaxel and their severity depend on how much of the drug is given. In other words, high doses may produce more severe side effects).
The Following Side Effects Are Common (Occurring In Greater Than 30%) For Patients Taking Docetaxel
- Low white blood cell count. (This can increase your risk for infection)
- Low red blood cell count (anemia)
Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts. Onset:4-7 days Nadir:5-9 days Recovery:21 days
- Fluid retention with weight gain, swelling of the ankles or abdominal area.
- Peripheral neuropathy (numbness in your fingers and toes) may occur with repeated doses. This should be reported to your healthcare provider.
- Mouth sores
- Hair loss
- Fatigue and weakness
- Nail changes (Color changes to your fingernails or toenails may occur while taking docetaxel. In extreme, but rare, cases nails may fall off. After you have finished docetaxel treatments, your nails will generally grow back) (see skin problem)
These side effect are less common, meaning they occur in 10-29 percent of patients receving docetsxel
- Muscle/bone/joint pain (myalgias and arthralgias)
- Low platelet count (This can increase your risk of bleeding)
- Increases in blood tests measuring liver function. These return to normal once treatment is discontinued. (see liver problems)
Infusion-related side effect include
- Allergic reactions (rash, flushing, fever, lowered blood pressure). Happens rarely, usually occurs in the first or second infusion. Frequency is reduced by premedication with corticosteroid starting one day before infusion. You will be monitored closely during the infusion for any signs of allergic reaction.
- Infusion site reactions (uncommon and generally mild, consist of darkening of the vein, inflammation, redness or dryness of the skin, or swelling of the vein). Not all side effects are listed above, some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms
CONTACT YOUR HEALTH CARE PROVIDER IMMEDIATELY, DAY OR NIGHT, IF YOU SHOULD EXPERIENCE ANY OF THE FOLLOWING SYMPTOMS:
- Fever of 100.4° F (38° C) or higher, chills (possible signs of infection)
THE FOLLOWING SYMPTOMS REQUIRE MEDICAL ATTENTION, BUT ARE NOT AN EMERGENCY. CONTACT YOUR HEALTH CARE PROVIDER WITHIN 24 HOURS OF NOTICING ANY OF THE FOLLOWING
- Nausea (interferes with ability to eat and unrelieved with prescribed medication).
- Vomiting (vomiting more than 4-5 times in a 24 hour period).
- Diarrhea (4-6 episodes in a 24-hour period).
- Unusual bleeding or bruising.
- Black or tarry stools, or blood in your stools or urine.
- Extreme fatigue (unable to carry on self-care activities).
- Mouth sores (painful redness, swelling or ulcers).
- Yellowing of the skin or eyes.
- Swelling of the ankles. Weight gain. Swelling of the stomach.
- Shortness of breath.
Always inform your health care provider if you experience any unusual symptoms.
- Before starting docetaxel treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
- Do not receive any kind of immunization or vaccination without your doctor’s approval while taking docetaxel.
- Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (docetaxel may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
- For both men and women: Do not conceive a child (get pregnant) while taking docetaxel. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breast feed while taking this medication.
- You may be at risk of infection so try to avoid crowds or people with colds or not feeling well, and report fever or any other signs of infection immediately to your health care provider.
- Wash your hands often.
- To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
- Use an electric razor and a soft toothbrush to minimize bleeding.
- Avoid contact sports or activities that could cause injury.
- To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing. Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition.
- If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
Monitoring and Testing
You will be checked regularly by your health care professional while you are taking docetaxel, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.
How this drug works
Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. “Normal” cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division)
The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis)
Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.
Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The “normal” cells will grow back and be healthy but in the meantime, side effects occur. The “normal” cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body.
Docetaxel belongs to a class of chemotherapy drugs called plant alkaloids. Plant alkaloids are made from plants. The vinca alkaloids are made from the periwinkle plant (catharanthusrosea). The taxanes are made from the bark of the Pacific Yew tree (taxus). The vinca alkaloids and taxanes are also known as antimicrotubule agents. The podophyllotoxins are derived from the May apple plant. Camptothecananalogs are derived from the Asian “Happy Tree” (Camptothecaacuminata). Podophyllotoxins and camptothecananalogs are also known as topoisomerase inhibitors. The plant alkaloids are cell-cycle specific. This means they attack the cells during various phases of division.
Vinca alkaloids: Vincristine, Vinblastine and Vinorelbine
- Taxanes: Paclitaxel and Docetaxel
- Podophyllotoxins:Etoposide and Tenisopide
Analogs:Irinotecan and Topotecan
Antimicrotubule agents (such as docetaxel), inhibit the microtubule structures within the cell. Microtubules are part of the cell’s apparatus for dividing and replicating itself. Inhibition of these structures ultimately results in cell death