docetaxel

High Alert

Locally advanced or metastatic breast cancer after failure of prior chemotherapy.
Adjuvant treatment of operable node-positive breast cancer (in combination with doxorubicin and cyclophosphamide).
Locally advanced or metastatic non-small cell lung cancer (NSCLC) after failure of prior platinum-based regimen.
Unresectable, locally advanced, or metastatic NSCLC in patients who have not previously received chemotherapy for this condition (in combination with cisplatin).
Metastatic castration-resistant prostate cancer (in combination with prednisone).
Locally advanced squamous cell carcinoma of the head and neck (in combination with cisplatin and fluorouracil).
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).

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to docetaxel, paclitaxel, or medications formulated with polysorbate 80;
Known alcohol intolerance;
Neutrophil count <1500/mm³;
Liver impairment (serum bilirubin > upper limit of normal [ULN], ALT and/or AST >1.5 times ULN, with alkaline phosphatase >2.5 times ULN);
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Rep: Women of reproductive potential and men with female partners of reproductive potential;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

CV: peripheral edema, CARDIAC TAMPONADE, PERICARDIAL EFFUSION

Derm: alopecia, edema, rash, ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS (AGEP), dermatitis, desquamation, erythema, nail disorders, STEVENS-JOHNSON SYNDROME (SJS), TOXIC EPIDERMAL NECROLYSIS (TEN)

EENT: cystoid macular edema

GI: diarrhea, nausea, stomatitis, vomiting, ASCITES, ENTEROCOLITIS, NEUTROPENIC COLITIS

GU: ↓fertility (males), amenorrhea

Hemat: anemia, leukopenia, thrombocytopenia

Local: injection site reactions

MS: myalgia, arthralgia

Neuro: fatigue, weakness, alcohol intoxication, neurosensory deficits, peripheral neuropathy

Resp: ACUTE RESPIRATORY DISTRESS SYNDROME, bronchospasm, dyspnea, INTERSTITIAL LUNG DISEASE, PULMONARY EDEMA, PULMONARY FIBROSIS

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS), MALIGNANCY (INCLUDING LEUKEMIAS, MYELODYSPLASTIC SYNDROME, NON-HODGKIN'S LYMPHOMA, AND RENAL CANCER), tumor lysis syndrome

Interactions ⬆ ⬇

Drug-drug:

↑bone marrow depression may occur with other antineoplastics or radiation therapy.
Strong inhibitors of CYP3A4, including atazanavir, clarithromycin, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, or voriconazole, ↑ levels and the risk of toxicity; avoid concomitant use (if need to use, ↓ docetaxel dose by 50%).

Availability ⬆ ⬇

(Generic available)

Solution for injection (concentrate): 10 mg/mL (dose of 100 mg/m² contains 0.15 g/m² of ethanol); 20 mg/mL (dose of 100 mg/m² contains 1.975 g/m² of ethanol)

Route/Dosage ⬆ ⬇

IV (Adults ): Breast cancer: 60–100 mg/m² every 3 wk; Breast cancer adjuvant therapy: 75 mg/m² every 3 wk for 6 cycles (with doxorubicin and cyclophosphamide); Non-small cell lung cancer: 75 mg/m² every 3 wk (alone or with platinum); Prostate cancer: 75 mg/m² every 3 wk (with oral prednisone); Squamous cell head and neck cancer: 75 mg/m² every 3 wk for 3–4 cycles (with cisplatin and fluorouracil); Gastric adenocarcinoma: 75 mg/m² every 3 wk (with cisplatin and fluorouracil).

US Brand Names ⬆ ⬇

Docivyx, ~~Taxotere~~

Action ⬆ ⬇

Interferes with normal cellular microtubule function required for interphase and mitosis.

Therapeutic effects:

Death of rapidly replicating cells, particularly malignant ones.

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: taxoids

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Widely distributed to tissues.

Metabolism/Excretion: Extensively metabolized by the liver via the CYP3A isoenzyme; metabolites undergo fecal elimination.

Half-Life: 116 hr.

Time/Action Profile ⬆ ⬇

(effect on blood counts)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	5–9 days	7 days

Patient/Family Teaching ⬆ ⬇

Explain purpose of docetaxel to patient.
Instruct patient to report symptoms of hypersensitivity reactions (trouble breathing; sudden swelling of face, lips, tongue, throat; trouble swallowing; hives; rash; redness all over body) to health care professional immediately.
Advise patient to notify health care professional if fever >101°F; chills; sore throat; signs of infection; bleeding gums; bruising; petechiae; or blood in urine, stool, or emesis occur. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor.
Patient should be cautioned to avoid alcohol and products containing aspirin or NSAIDs.
Fatigue is a frequent side effect of docetaxel. Advise patient that frequent rest periods and pacing of activities may minimize fatigue.
Instruct patient to notify health care professional if signs of fluid retention (peripheral edema in the lower extremities, weight gain, dyspnea), colitis (abdominal pain or tenderness, diarrhea, with or without fever), yellow skin, weakness, paresthesia, gait disturbances, swelling of the feet, or joint or muscle aches occur.
Alcohol content of docetaxel may impair CNS. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Instruct patient to inspect oral mucosa for redness and ulceration. If mouth sores occur, advise patient to use sponge brush and rinse mouth with water after eating and drinking.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
Advise patient to notify health care professional if changes in vision occur. Obtain a prompt and comprehensive ophthalmologic examination. May require discontinuation of docetaxel and use of a nontaxane cancer therapy.
Discuss with patient the possibility of hair loss. Complete hair loss usually begins after 1 or 2 treatments and is reversible after discontinuation of therapy. Explore coping strategies.
Instruct patient not to receive any vaccinations without advice of health care professional.
Rep: May cause fetal harm. Advise females of reproductive potential to use effective contraception during and for 2 mo after last dose of therapy and to avoid breastfeeding during and for 1 wk after last dose. Advise men with female partners of reproductive potential to use effective contraception during and for 4 mo after last dose of therapy. May impair fertility in male patients.
Emphasize the need for periodic lab tests to monitor for side effects.

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Indications ⬇