DOCETAXEL 
Pronounciation
- (doh-seh-TAX-ell)
Trade Name(s)
- Taxotere
- Antineoplastic agent (taxane)
Verify pregnancy status. Baseline studies indicated; see Monitor.
Premedication for all patients except those with castration-resistant prostate cancer:
Must be pretreated with oral corticosteroids to reduce the incidence and severity of fluid retention and hypersensitivity reactions. Usual regimen is dexamethasone 8 mg PO twice a day for 3 days. Begin 1 day before each docetaxel infusion.
Premedication for hormone-refractory prostate cancer:
Administer oral dexamethasone 8 mg at 12 hours, 3 hours, and 1 hour before each docetaxel infusion (another steroid, prednisone, is part of the combination therapy).
60 to 100 mg/M2 as an infusion. Repeat every 3 weeks.
Combination therapy for adjuvant treatment of operable node-positive breast cancer:
75 mg/M2 as an infusion. Administer 1 hour after doxorubicin 50 mg/M2 and cyclophosphamide 500 mg/M2. Repeat every 3 weeks for 6 cycles. Prophylactic G-CSF (e.g., filgrastim) may be used to mitigate the risk of hematologic toxicity. See doxorubicin and cyclophosphamide monographs.
Prostate cancer (castration-resistant):
75 mg/M2 as an infusion. Repeat every 3 weeks. Prednisone 5 mg PO twice daily is administered continuously throughout treatment. See Premedication.
Non–small-cell lung cancer (NSCLC) in chemotherapy-naïve patients:
75 mg/M2 as an infusion over 1 hour. Follow immediately with cisplatin 75 mg/M2 as an infusion over 30 to 60 minutes. Repeat regimen every 3 weeks. Premedicate with antiemetics and hydration as required for cisplatin administration; see cisplatin monograph.
NSCLC after failure of prior chemotherapy:
75 mg/M2 as an infusion. Repeat every 3 weeks. Larger doses increased toxicity, infection, and treatment-related mortality.
75 mg/M2 as an infusion over 1 hour. Follow immediately with cisplatin 75 mg/M2 as an infusion over 1 to 3 hours (both on Day 1 only). Premedicate with antiemetics and hydration as required for cisplatin administration; see cisplatin and fluorouracil monographs. Follow the cisplatin infusion with fluorouracil 750 mg/M2 as an infusion equally distributed over 24 hours. Repeat fluorouracil dose for 4 more 24-hour infusions (total of 5 days). Repeat regimen every 3 weeks. In the study, G-CSF (filgrastim) was recommended during the second and/or subsequent cycles to prevent or attenuate febrile neutropenia, documented infection with neutropenia, or neutropenia lasting more than 7 days.
Induction chemotherapy followed by radiotherapy for treatment of inoperable, locally advanced squamous cell cancer of the head and neck (SCCHN):
75 mg/M2 as an infusion over 1 hour. Follow immediately with cisplatin 75 mg/M2 as an infusion over 1 hour (both on Day 1 only). Premedicate with antiemetics and hydration as required for cisplatin administration; see cisplatin monograph. Follow the cisplatin infusion with fluorouracil 750 mg/M2 as an infusion equally distributed over 24 hours. Repeat fluorouracil for four more 24-hour infusions (total of 5 days). See fluorouracil monograph. Repeat regimen every 3 weeks for a total of four cycles. Prophylactic antibiotics were used in clinical studies. In the study, G-CSF (filgrastim) was recommended during the second and/or subsequent cycles to prevent or attenuate febrile neutropenia, documented infection with neutropenia, or neutropenia lasting more than 7 days. Following chemotherapy, patients should receive radiotherapy.
Induction chemotherapy followed by chemoradiotherapy for treatment of locally advanced (unresectable, low surgical cure, or organ preservation) SCCHN:
75 mg/M2 as an infusion over 1 hour. Follow with cisplatin 100 mg/M2 as a 30-minute to 3-hour infusion (both on Day 1 only). Premedicate with antiemetics and hydration as required for cisplatin administration; see cisplatin monograph. Follow the cisplatin infusion with fluorouracil 1,000 mg/M2 as an infusion equally distributed over 24 hours. Repeat fluorouracil for three more 24-hour infusions (total of 4 days). See fluorouracil monograph. Repeat regimen every 3 weeks for 3 cycles. Prophylactic antibiotics were used in clinical studies. In the study, G-CSF (filgrastim) was recommended during the second and/or subsequent cycles to prevent or attenuate febrile neutropenia, documented infection with neutropenia, or neutropenia lasting more than 7 days. Following chemotherapy, patients should receive chemoradiotherapy.
Treatment of ovarian cancer (unlabeled):
60 to 75 mg/M2 as an infusion in combination with carboplatin. Repeat every 3 weeks.
Metastatic bladder cancer (unlabeled):
100 mg/M2 every 3 weeks as a single agent or 35 mg/M2 on Days 1 and 8 of a 21-day cycle in combination with gemcitabine and cisplatin. Administer for at least 6 cycles or until disease progression or unacceptable toxicity.
Treatment of esophageal cancer (unlabeled):
75 mg/M2 as a 1-hour infusion every 21 days used in combination with fluorouracil and cisplatin.
Withhold therapy if neutrophils below 1,500/mm3 or platelets below 100,000 cells/mm3. A 25% reduction in the dose of docetaxel is recommended during subsequent cycles following severe neutropenia (less than 500/mm3) lasting 7 days or more, febrile neutropenia, or a Grade 4 infection. ■ Withhold therapy if bilirubin is greater than the ULN or if AST and/or ALT is greater than 1.5 times the ULN concomitant with alkaline phosphatase greater than 2.5 times the ULN.■ Discontinue therapy in patients who develop Grade 3 or higher peripheral neuropathy. ■ Dose selection should be cautious in the elderly. Reduced doses may be indicated based on the potential for decreased organ function and concomitant disease or drug therapy. ■ Consider additional dose adjustments when docetaxel is given in combination with other chemotherapeutic agents. ■ See Precautions and Drug/Lab Interactions.
Reduce dose to 75 mg/M2 for patients initially dosed at 100 mg/M2 who experience febrile neutropenia, severe neutropenia (neutrophils below 500/mm3 for more than 1 week), severe or cumulative cutaneous reaction, or severe peripheral neuropathy. Further reduce to 55 mg/M2 or discontinue docetaxel if any of the previously listed reactions persist. ■ Patients receiving the lower dose of docetaxel (60 mg/M2) may have the dose increased gradually if lower dose was well tolerated. ■ Discontinue therapy in patients who develop Grade 3 or greater peripheral neuropathy.
Combination therapy for adjuvant treatment of operable node-positive breast cancer:
Patients who experience febrile neutropenia should receive G-CSF (e.g., filgrastim) in all subsequent cycles. Patients who continue to experience this reaction should remain on G-CSF and have their docetaxel dose decreased to 60 mg/M2. ■ Reduce docetaxel dose to 60 mg/M2 in patients who experience Grade 3 or 4 stomatitis. ■ Reduce docetaxel dose from 75 to 60 mg/M2 in patients who experience severe or cumulative cutaneous reactions or moderate neurosensory signs and/or symptoms. If side effects persist at the lower dose, discontinue therapy.
Reduce docetaxel dose from 75 to 60 mg/M2 in patients who experience dose-limiting toxicities (e.g., febrile neutropenia, neutrophils less than 500 cells/mm3 for more than 1 week, severe or cumulative cutaneous reactions, or moderate neurosensory signs and/or symptoms). If side effects persist at the lower dose, discontinue therapy.
Non–small-cell lung cancer after failure of prior chemotherapy:
In NSCLC patients who experience either febrile neutropenia, neutrophils less than 500 cells/mm3 for more than 1 week, severe or cumulative cutaneous reactions, or other Grade 3 or 4 nonhematologic toxicities, withhold docetaxel until resolution of toxicity, then resume at 55 mg/M2. ■ Discontinue therapy in patients who develop Grade 3 or greater peripheral neuropathy.
Non–small-cell lung cancer (NSCLC) in chemotherapy-naïve patients:
Reduce dose to 65 mg/M2 in patients whose nadir of platelet count during the previous course of therapy was less than 25,000 cells/mm3, in patients who experienced febrile neutropenia, and in patients with serious nonhematologic toxicities. Dose may be further reduced to 50 mg/M2 as indicated. See cisplatin monograph for cisplatin dose adjustments.
Gastric adenocarcinoma and head and neck cancer:
Patients who experience febrile neutropenia, documented infection with neutropenia, or neutropenia lasting more than 7 days should receive G-CSF (e.g., filgrastim) in all subsequent cycles. Patients who continue to experience this reaction should remain on G-CSF and have their docetaxel dose decreased to 60 mg/M2. Reduce dose further to 45 mg/M2 if subsequent episodes of complicated neutropenia occur. ■ Reduce docetaxel dose from 75 to 60 mg/M2 in patients who experience Grade 4 thrombocytopenia. ■ Hold subsequent cycles of docetaxel until neutrophils recover to a level of greater than 1,500 cells/mm3 and platelets recover to a level greater than 100,000 cells/mm3. ■ If the previously mentioned toxicities persist, discontinue therapy. ■ Additional dose adjustments are outlined in the following chart.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Specific techniques required; see Precautions. If docetaxel or diluted solution comes into contact with skin, immediately and thoroughly wash with soap and water. If docetaxel or diluted solution comes into contact with mucosa, immediately and thoroughly wash with water.
Available in multiple formulations, in several concentrations, and as both single-use and multiple-use products; read label carefully. Formulations are NOT interchangeable in a dose. Do not use the two-vial formulation (injection concentrate and diluent [contains 13% ethanol in water for injection]) with the one-vial formulation. Read prescribing information carefully for product-specific dilution, storage, and stability information.
Single-bottle formulations (generic and Taxotere):
Available in 10 mg/mL and 20 mg/mL concentrations in multiple sizes. Manually rotate to mix thoroughly. Requires no initial dilution and is ready to add to an infusion solution; read label carefully to avoid overdose. Allow required number of vials to stand at room temperature for 5 minutes if refrigerated. Using a 21-gauge needle (product specific), withdraw required amount of docetaxel and inject via a single injection into a 250-mL infusion bag or bottle of NS or D5W; see all formulations below. Manually rotate to mix thoroughly.
Two-vial formulation (generic):
Available in 20 mg/0.5 mL or in 80 mg/2 mL vials (concentration is 2 times greater than the single-bottle formulation; read label carefully). Allow required number of vials to stand at room temperature for 5 minutes if refrigerated. Reconstitute the appropriate vial (20 or 80 mg) with the entire contents of the diluent vial. Resulting concentration is 10 mg/mL. Mix well by repeated inversions for at least 45 seconds. Do not shake. Allow to stand until most of the foam dissipates. After this initial reconstitution, withdraw the required amount of 10 mg/mL concentrate and inject into a 250-mL bag or bottle of NS or D5W; see all formulations below.
Final dilution should be in glass or polypropylene bottles or polypropylene or polyolefin plastic bags for infusion. Thoroughly mix the infusion by manual rotation. Should be administered through polyethylene-lined administration sets. Desired concentration should be between 0.3 and 0.74 mg/mL (100 mg in 250 mL = 0.4 mg/mL). If a dose greater than 200 mg is required, use a larger volume of NS or D5W so that a final concentration of 0.74 mg/mL is not exceeded. Solution should be clear.
Not required.
Storage requirements and stability are brand specific; check prescribing information. Some products may be stored at RT. Others require refrigeration. Docetaxel injection infusion solution is supersaturated and may therefore crystallize over time. If crystals appear, the solution must no longer be used and should be discarded.
Most formulations when fully diluted in NS or D5W should be used within 4 hours (including the 1-hour infusion time). Taxotere (one-vial formulation) is stable for 6 hours (including the 1-hour infusion time). At least one generic product is available as a multiple-dose vial that is stable for 28 days when refrigerated.
Leaches out plasticizers, including DEHP, from PVC infusion bags and administration sets. Use glass or polypropylene bottles or plastic (polypropylene or polyolefin) bags and polyethylene-lined administration sets to minimize patient exposure to leached DEHP. Do not allow concentrate to come into contact with plasticized PVC equipment or devices used to prepare and administer solutions.
Other sources suggest specific compatibilities dependent on concentration and manufacturer; consult a pharmacist.
A single dose, properly diluted, equally distributed over 1 hour. Room temperature should be cool and lighting should be low.
An antineoplastic. A novel, semisynthetic, antimicrotubule agent derived from the needles of the yew plant. It inhibits cancer cell division. Microtubules assemble and disassemble during the cell cycle. Docetaxel promotes assembly and blocks disassembly of microtubules, preventing the cancer cells from dividing. The end result is cancer cell death. Highly protein bound. Metabolized in the liver by CYP3A4, an isoenzyme of the P450 family. Half-life is 11.1 hours. Eliminated primarily through feces and, to a lesser extent, urine and bile.
Treatment of locally advanced or metastatic breast cancer after failure of prior chemotherapy. ■ In combination with doxorubicin and cyclophosphamide for adjuvant treatment of operable node-positive breast cancer. ■ As a single agent in the treatment of locally advanced or metastatic NSCLC after failure of platinum-based chemotherapy (e.g., cisplatin). ■ In combination with cisplatin for treatment of patients with unresectable, locally advanced, or metastatic NSCLC who have not previously received chemotherapy for this condition. ■ In combination with prednisone for the treatment of castration-resistant metastatic prostate cancer. ■ In combination with cisplatin and fluorouracil for the treatment of advanced gastric adenocarcinoma, including adenocarcinoma of the gastroesophageal junction, in patients who have not received prior chemotherapy for advanced disease. ■ In combination with cisplatin and fluorouracil for induction therapy of locally advanced SCCHN. Following chemotherapy, patients should receive radiotherapy.
Treatment of metastatic bladder cancer, esophageal cancer, ovarian cancer, soft tissue sarcomas, and adenocarcinomas of unknown primary site; consult literature.
Baseline neutropenia less than 1,500 cells/mm3.■History of hypersensitivity reactions to docetaxel or other drugs formulated with polysorbate 80.■ Severe impaired liver function. In the United States, docetaxel is not recommended for patients with a bilirubin above the ULN or in patients with ALT and/or AST greater than 1.5 times the ULN range and increases in alkaline phosphatase greater than 2.5 times the ULN range; see Precautions.
Follow guidelines for handling cytotoxic agents. See Appendix A. ■ Usually administered by or under the direction of the physician specialist. ■ Adequate diagnostic and treatment facilities must be readily available. ■ Incidence of treatment-related mortality increased in patients with abnormal liver function, in patients receiving higher doses, and in patients with NSCLC and a history of prior treatment with platinum-based chemotherapy who receive docetaxel as a single agent at a dose of 100 mg/M2.■ Patients with elevations of bilirubin or abnormalities of transaminase concurrent with alkaline phosphatase are at increased risk for the development of Grade 4 neutropenia, febrile neutropenia, infections, severe thrombocytopenia, severe stomatitis, severe skin toxicity, and toxic death.■ Not recommended for patients with hepatic impairment; see Contraindications. Risk of toxicity and death is significant. Patients with isolated elevations of transaminases greater than 1.5 times the ULN have a higher rate of neutropenia Grade 4 but not of toxic death. Alcohol content of some products should be considered if given to patients with hepatic impairment. ■ Reversible myelosuppression is the major dose-limiting toxicity of docetaxel. The median time to nadir was 7 days, and the median duration of severe neutropenia (fewer than 500 cells/mm3) was 7 days. ■ Febrile neutropenia occurred in patients dosed at 100 mg/M2 but was uncommon in patients dosed at 60 mg/M2. Hematologic responses, febrile reactions and infections, and rates of septic death for different regimens are dose related. ■ Enterocolitis and neutropenic colitis (typhlitis) have occurred despite the coadministration of G-CSF. Use caution in patients with neutropenia, particularly in patients at risk for developing GI complications. ■ Severe hypersensitivity reactions characterized by generalized rash/erythema, hypotension and/or bronchospasm or, rarely, fatal anaphylaxis have been reported.■ Patients who have previously experienced a hypersensitivity reaction to paclitaxel may develop a hypersensitivity reaction to docetaxel that may include severe or fatal reactions such as anaphylaxis. ■ In addition to myelosuppression and hypersensitivity reactions, localized erythema of the extremities with edema followed by desquamation, severe fluid retention, severe neurosensory symptoms (e.g., dysesthesia, pain, paresthesia), and severe asthenia (usually in metastatic breast cancer patients) has been reported. ■ Severe fluid retention may occur despite premedication with dexamethasone.■ Use with caution in patients with pleural effusion; may be exacerbated by docetaxel-induced fluid retention. ■ Second primary malignancies, notably acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), non-Hodgkin lymphoma (NHL), and renal cancer have been reported in patients treated with docetaxel-containing regimens. May occur months to years after docetaxel-containing therapy. ■ Cystoid macular edema (CME) has been reported; see Monitor. ■ Cases of intoxication have been reported with some formulations of docetaxel due to the alcohol content. Alcohol content may affect the CNS and should be considered in patients in whom alcohol intake should be avoided or minimized. May affect ability to drive or use machinery immediately after the infusion. ■ When administering combination therapy, consult all appropriate drug monographs for relevant information. ■ See Drug/Lab Interactions.
Obtain baseline CBC with differential and platelets; monitor frequently during therapy and before each dose. See Dose Adjustments. ■ Obtain baseline bilirubin, AST, ALT, and alkaline phosphatase; monitor as indicated during therapy (recommended before each dose).■ Obtain baseline and periodic renal function, if indicated. ■ Determine absolute patency of vein. A stinging or burning sensation indicates extravasation; discontinue injection; use another vein. ■ Obtain baseline vital signs; monitor during and after infusion. ■ Monitor for hypersensitivity reactions, especially during the first and second infusions; may occur within minutes. Discontinue docetaxel if reaction is severe. Hypersensitivity reactions may occur even in patients premedicated with dexamethasone.■ Closely monitor patients with a previous history of hypersensitivity to paclitaxel during initiation of docetaxel therapy. ■ Monitor for localized erythema of the palms of the hands and soles of the feet with or without desquamation. Skin eruptions generally occur within 1 week after docetaxel infusion, resolve before the next infusion, and are not disabling. However, severe reactions have been reported. A reduced dose may be indicated if severe. ■ Monitor for fluid retention. Salt restriction and treatment with oral diuretics may be indicated. S/S of severe fluid retention include abdominal distension (severe), cardiac tamponade, dyspnea at rest, peripheral or generalized edema, pleural effusion.■ Observe for signs of peripheral neurotoxicity (e.g., neurosensory symptoms such as dysesthesia, pain, paresthesia, and peripheral motor neuropathy manifested primarily as distal extremity weakness); docetaxel may need to be discontinued; see Dose Adjustments. In patients with gastric adenocarcinoma or SCCHN, a baseline neurologic exam is recommended. Repeat every 2 cycles and at the end of treatment; see Dose Adjustments. ■ Monitor patients for the onset of any GI toxicity. Enterocolitis and neutropenic enterocolitis may develop at any time and can lead to death as early as the first day of symptom onset. ■ Observe for signs of infection. Use of prophylactic antibiotics may be indicated pending C/S in a febrile, neutropenic patient. Monitor patients receiving docetaxel (Taxotere), cisplatin, fluorouracil (5-FU) combination therapy closely for febrile neutropenia and/or neutropenic infection. ■ Monitor for thrombocytopenia (platelet count less than 50,000/mm3); see Dose Adjustments. Initiate precautions to prevent excessive bleeding (e.g., inspect IV sites, skin, and mucous membranes; use extreme care during invasive procedures; test urine, emesis, stool, and secretions for occult blood). ■ Monitor for signs of existing or developing impaired vision. A prompt comprehensive ophthalmologic exam is indicated. If CME is diagnosed, discontinue docetaxel. ■ Hematologic follow-up required due to risk of delayed second primary malignancies.
Avoid pregnancy. Females of reproductive potential should use effective contraception during treatment and for 6 months after the last dose of docetaxel. Male patients with female partners of reproductive potential should use effective contraception during treatment and for 3 months after the last dose. ■ May impair fertility in males of reproductive potential. ■ Review of monitoring requirements (e.g., CBCs, liver function tests) and adverse events before therapy imperative. ■ Pretreatment with dexamethasone as prescribed is imperative. ■ Report pain or burning at injection site and any unusual or unexpected symptoms or side effects as soon as possible (e.g., constipation, diarrhea, excessive tearing, fatigue, fever, hair loss [cases of permanent hair loss have been reported], hypersensitivity reaction [e.g., difficulty breathing, itching, rash], infusion site reaction, irregular and/or rapid heartbeat, nausea and vomiting, shortness of breath, swelling of feet and legs, weight gain, change in vision). ■ Promptly report new or worsening symptoms of GI toxicity. ■ Immediately report myalgia or cutaneous or neurologic reactions. ■ Review all medications (prescription and nonprescription) and allergies with nurse and/or physician. ■ Medication may contain alcohol. May affect ability to drive or operate machinery immediately after infusion. ■ SeeAppendix D, p. 1311. ■ Obtain name and telephone number of a contact person for emergencies, questions, or problems. ■ Seek resources for counseling or supportive therapy. ■ Risk of second primary malignancies requires hematologic follow-up. Changes in blood counts due to leukemia and other blood disorders may occur years after treatment.
Avoid pregnancy; may cause fetal harm. ■ Avoid breast-feeding during treatment and for 1 week after the last dose of docetaxel. ■ Effectiveness in pediatric patients as monotherapy or in combination have not been established. The overall safety profile of docetaxel in pediatric patients receiving monotherapy or combination treatment with cisplatin and 5-fluorouracil was consistent with the known safety profile in adults. Has been used in a small number of pediatric patients; see manufacturer’s prescribing information. ■ The alcohol content of docetaxel should be taken into account when given to pediatric patients.
Dose selection should be cautious; see Dose Adjustments. ■ May be at increased risk for developing side effects such as anemia, anorexia, diarrhea, dizziness, febrile neutropenia, infections, lethargy, nail changes, peripheral edema, stomatitis, and weight loss. ■ Monitor hepatic function carefully.
A substrate of CYP3A4. Metabolism may be modified by concomitant administration of other medications that induce, inhibit, or are metabolized by CYP3A4 (e.g., cyclosporine, phenytoin, phenobarbital, tacrolimus, and many others). ■ Metabolism inhibited and serum levels increased with strong CYP3A4 inhibitors (e.g., imidazole antifungals [e.g., itraconazole, voriconazole], protease inhibitors [e.g., atazanavir, indinavir, nelfinavir, ritonavir, saquinavir], clarithromycin, and nefazodone). Avoid use. A pharmacokinetic study suggests considering a 50% dose reduction of docetaxel if coadministration of a strong CYP3A4 inhibitor is required; monitor closely for toxicity. ■ Docetaxel clearance is not affected by coadministration of prednisone, dexamethasone, fluorouracil, cyclophosphamide, doxorubicin, or cisplatin. ■ Do not administer live virus vaccines to patients receiving antineoplastic agents.
Generally reversible but can be fatal. The most common side effects across all indications are alopecia, anemia, anorexia, asthenia, constipation, diarrhea, dysgeusia, dyspnea, febrile neutropenia, fluid retention (e.g., ascites, edema, pericardial effusion, pleural effusion), hypersensitivity reactions (e.g., back pain, chest tightness, chills, drug fever, dyspnea, flushing, hypotension, pruritus, rash), infection, mucositis, myalgia, nail disorders, nausea, neuropathy, neutropenia, pain, skin reactions, thrombocytopenia, and vomiting. Increased incidence of bone marrow suppression (anemia, leukopenia, neutropenia, thrombocytopenia) and/or severity of side effects is dose dependent and can be dose limiting. The most serious adverse reactions are alcohol intoxication, asthenia, cutaneous reactions, enterocolitis and neutropenic colitis, eye disorders, fluid retention, hematologic toxicity, hepatotoxicity, hypersensitivity, neurologic reactions, second primary malignancies, and toxic deaths. Abdominal pain; acute myeloid leukemia and myelodysplastic syndrome; acute pulmonary edema; acute respiratory distress syndrome; alcohol intoxication; altered hearing; amenorrhea; arthralgia; bleeding episodes; cardiac arrhythmias; CHF; colitis; confusion; conjunctivitis; cough; cutaneous reactions (e.g., localized rash on hands, feet, arms, face, thorax; erythema multiforme; severe hand and foot syndrome; Stevens-Johnson syndrome; toxic epidermal necrolysis); diarrhea; DIC (often in association with sepsis or multiorgan failure); dizziness; enteritis; esophagitis/dysphagia/odynophagia; eye disorders (e.g., CME); fatigue; fever with or without infection; gastrointestinal pain and cramping; heartburn; hepatitis (sometimes fatal, primarily in patients with pre-existing liver disease); hypotension; increased ALT, AST, and bilirubin; infusion site reactions; interstitial pneumonia; lethargy; lymphedema; myocardial ischemia; neurosensory symptoms (e.g., dysesthesia, pain, paresthesia); neutropenic infection; paresthesias (e.g., pain, burning sensation); perforation of the large intestine; renal insufficiency; seizures or transient loss of consciousness; stomatitis; taste perversion; tearing; vasodilation.
Bone marrow suppression, mucositis, peripheral neurotoxicity.
Acute pulmonary edema, acute respiratory distress syndrome/pneumonitis, alopecia (permanent), anaphylactic shock, atrial fibrillation, bullous eruptions, chest pain, cutaneous lupus erythematosus, cystoid macular edema, deep vein thrombosis, dehydration, diffuse pain, disseminated intravascular coagulation (DIC) (often in association with sepsis or multiorgan failure), duodenal ulcer, dyspnea, ECG abnormalities, esophagitis, gastrointestinal perforation, GI hemorrhage, hearing disorders/loss, hepatitis, hyponatremia, ileus, interstitial lung disease, interstitial pneumonia, intestinal obstruction, ischemic colitis, lacrimation with or without conjunctivitis, MI, myelodysplastic syndrome, neutropenic enterocolitis, ototoxicity, pulmonary embolism, pulmonary fibrosis, radiation pneumonitis, radiation recall phenomenon, renal failure (most commonly associated with concomitant nephrotoxic drugs), renal insufficiency, respiratory failure, scleroderma-like changes (usually preceded by peripheral lymphedema), seizures, syncopy, tachycardia, thrombophlebitis, transient loss of consciousness, transient visual disturbances.
Keep physician informed of all side effects. Most will be treated symptomatically as indicated. Most hypersensitivity reactions will subside with temporary discontinuation of docetaxel, and incidence seems to decrease with subsequent doses. Discontinue docetaxel if a severe hypersensitivity reaction occurs. Severe reactions may require epinephrine, antihistamines (e.g., diphenhydramine), corticosteroids (e.g., dexamethasone), or bronchodilators (e.g., albuterol). Patients with a history of a severe hypersensitivity reaction should not be rechallenged. If CME is diagnosed, discontinue docetaxel and initiate appropriate treatment. Consider alternative non-taxane cancer treatment. Neutropenia can be profound. Recovery is generally rapid and spontaneous but may be treated with filgrastim or pegfilgrastim. Severe thrombocytopenia may require platelet transfusions. Severe anemia (less than 8 Gm/dL) may require packed cell transfusions. Serious cutaneous reactions with desquamation (rare), serious fluid retention, persistent febrile neutropenia, severe peripheral neuropathy, or severe liver impairment may require discontinuation of docetaxel. There is no specific antidote for overdose. Supportive therapy will help sustain the patient in toxicity. Resuscitate if indicated.