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Docetaxel (“Taxotere”)


	Docetaxel is one of the most active of all anti-cancer drugs, and shows particular activity against breast cancer. It belongs to a class of anti-cancer drugs called “taxanes”, of which the prototype is paclitaxel, or Taxol. Although it shares some features with paclitaxel, it has some particular features also. Dose schedules and combinations. Docetaxel is used either as a single agent, or sometimes in combination with other chemotherapy drugs, or with the anti-breast cancer drug, Herceptin. For breast cancer it is most commonly given as a single agent, either once every three weeks, or weekly. It is given by intravenous injection over about 90 minutes. When given weekly, it is common to have a 2-week break every 8 weeks. Side Effects of Docetaxel The side-effects of docetaxel depend on whether it is given weekly or third weekly. The main side-effects are considered in detail elsewhere – just follow the links to find out more about each one and to read some tips on how to manage and minimize the symptoms. They include: Alopecia (hair loss). This depends on whether or not the docetaxel is given weekly or third weekly. When given third weekly, docetaxel always causes dramatic hair loss, including the scalp, eyebrows, eyelashes and other body hair. Hair loss occurs about 3-4 weeks after the first dose. When the weekly schedule is used hair loss is much more variable, often gradual and not usually complete. After treatment with docetaxel has ended, normal hair growth should return. Nausea. This is an uncommon side-effect of docetaxel and often anti-nausea drugs are not required at all. It virually never occurs with the weekly schedule. Low white blood cells and infection. This is very uncommon with the weekly schedule, but you still need to take the precaution of reporting for medical care in the event of fever over 38 degrees centigrade. Altered menstrual cycle and early menopause . Allergic reactions . These may consist of fever or chills; flushing of face; lower back or side pain accompanied by fever or chills; mild shortness of breath and occasional chest discomfort; skin rash or itching. Sometimes this occurs acutely during the infusion and often responds to a slowing down of the drip rate. We routinely give intravenous or oral dexamethasone before the docetaxel, and sometimes after it. Your chemotherapy nurse will supervise this. Fluid retention Some patients experience fluid retention, usually after at least two months of treatment. This can occur as mild swelling of the extremities (“oedema”), and occasionally may lead to fluid collecting in the sack around the heart (“pericardial effusion”) or the linings of the lungs (“pleural effusion”). This usually causes breathlessness, and is usually readily treated by draining the fluid and ceasing the drug. It usually occurs gradually rather than suddenly, and your oncologist will be carefully monitoring for it. It is reduced by the regular use of dexamethasone as a pre-medication. Skin and nail changes Docetaxel commonly produces redness, drying and cracking of the hands and feet, and often quite severe drying and cracking of the nails. These effects tend to occur gradually after several months of treatment, and often respond to dose reduction.There are anecdotal reports that the nail changes can be minimised by using cold gloves during administration of the drug and by using black nail polish. It is hard for me to understand why this would work, but the nursing staff swear by it, and I guess you have nothing to lose by giving it a go! Certainly the regular use of moisturing creams, and using gloves for household tasks are both sensible preventative measures. Tiredness and Fatigue (“Aesthenia”) This tends to occur gradually after several months of treatment. Muscle pains (“Myalgia”) This only occurs with the third-weekly schedule. Pain in joints or muscles, especially in the back and legs may begins 2 to 3 days after treatment and may last up to 5 days. It feels like “’flu” pain, and may need strong pain killers like Panadeine Forte. Loss of sensation (“Sensory neuropathy”) Docetaxel causes reversible damage to the sensory nerves. This leads to “pins and needles” in the fingers and toes, and sometimes tenderness or odd burning sensations in the palms and soles, but especially the feet. It comes on after about two months of treatment, and may take as long as nine months to resolve after the treatment finishes. 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