Posted on April 28th, 2009 by
Generic Name: Docetaxel (doe-se-TACKS-sel)
Trade Name: Taxotere®
For which conditions is this drug approved? Docetaxel is FDA approved for the treatment of:
It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who are prescribed docetaxel for conditions other than the ones it has been approved for may wish to discuss this issue with their physician.
What is the mechanism of action? Docetaxel belongs to a class of drugs called taxanes, or anti-microtubule agents. Docetaxel produces its anti-cancer effects by causing abnormalities in microtubule formation in cells. Microtubules are components of cells that provide structural framework that enables cells to divide and grow. The abnormal microtubule formation caused by docetaxel inhibits cellular replication and ultimately causes cellular death.
How is docetaxel typically given (administered)? Docetaxel is administered intravenously (into a vein) and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used, and the overall health of the patient.
Reactions to docetaxel may occur during administration, and patients will be treated with a steroid, dexamethasone, three days prior to infusion and one day following infusion to help minimize this reaction. Although patients will be closely monitored for reactions including low blood pressure during or immediately following administration of docetaxel, patients should tell their healthcare provider if they experience difficulty breathing, lightheadedness or dizziness, redness of the face, or a rash.
Patients may develop severe fliud retention characterized by swelling of the extremities, weight gain and generalized swelling, fluid surrounding the lungs, difficulty breathing and abdominal distention.
How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with docetaxel. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. In addition, reflexes may be tested, as docetaxel can result in numbness of fingers or toes.
What are the common (occur in 30% or more of patients) side effects of treatment with docetaxel?
• Low white blood cell levels – increases risk of infection
• Low red blood cell levels – increases risk of anemia or blood transfusions
• Mouth sores
• Generalized fatigue or weakness
• Numbness tingling or pain of fingers or toes
• Hair loss
• Fluid retention in the ankles or abdomen
• Color changes of nails
What are the less common (occur in 10% to 29% of patients) side effects of treatment with docetaxel?
• Allergic type reaction, may include flushing, rash, itching, chest tightness, back pain, diffculty breathing, fever, chills
• Low platelet levels – increases risk of bleeding
• Abnormalities in liver function levels as determined by blood tests
• Muscle pain
• Joint pain
This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.
Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.
What can patients do to help alleviate or prevent discomfort and side effects?
• Since docetaxel may cause numbness of the fingers or toes, patients should use caution around extreme heat or cold
• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Follow the schedule and exact dose of dexamethasone prescribed to help prevent serious fluid retention.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Eat small meals frequently to help alleviate nausea.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• For mouth sores, patients should rinse their mouth three times a day with a salt and soda solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.
Are there any special precautions patients should be aware of before starting treatment?
• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
When should patients notify their physician?
• Numbness, tingling or pain of fingers or toes
• Yellowing of skin and eyes
• Fluid retention in ankles or abdomen
• Weigh gain
• Muscle pain or joint pain
• Persistent diarrhea
• Extreme or persistent nausea and vomiting
• Mouth sores
• Difficulty breathing
• Redness of the face
• Lightheadedness or dizziness
• Rash, itching
• Fever, chills, cough, sore throat, flu or cold-like symptoms
• Signs of infection – redness, swelling, pus, tenderness, painful or frequent urination
• Persistent or severe fatigue
• Unexplained or excessive bleeding (nosebleeds, bruising, black tarry stools, blood in the urine, etc.)
• Signs of an allergic reaction – flushing, rash, itching, chest tightness, back pain, diffculty breathing, fever, chills
What is a package insert? A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.
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