Names and pronunciation
(doe-se-tax′el) Taxotere
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Drug reference
(doe-se-tax′el) Taxotere
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Func. class.: Antineoplastic—miscel- laneous
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Chem. class.: Taxane
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Do not confuse: Taxotere/Taxol
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ACTION: Inhibits reorganization of microtubule network needed for inter- phase and mitotic cellular functions; also causes abnormal bundles of microtu- bules during cell cycle and multiple esters of microtubules during mitosis
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USES: Locally advanced or metastatic breast cancer, non–small-cell lung can- cer, androgen-independent metastatic prostate cancer, postsurgery operable node-positive breast cancer, induction treatment of locally advanced squamous cell carcinoma of the head and neck, gastric adenocarcinoma
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CONTRAINDICATIONS: Preg- nancy, breastfeeding, hypersensitivity to this product, bilirubin exceeding ULN
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Black Box Warning: Other products with polysorbate 80, neutropenia of <1500/ mm3 Precautions: Children, cardiovascular disease, pulmonary disorders, bone mar- row depression, herpes zoster, pleural effusion Black Box Warning: Edema, hepatic dis- ease, lung cancer, taxane hypersensitivity Black Box Warning: Neutropenia: CBC, differential, platelet count prior to treatment and weekly; withhold product if WBC is <1500/mm3 or platelet count is <100,000/ mm3; notify prescriber, nadir 8 days Black Box Warning: DOCEtaxel, poly- sorbate 80 hypersensitivity: contraindi- cated; some products may contain poly- sorbate 80 Black Box Warning: Edema: oral corti- costeroids should be given as premedi- cation; assess for fluid retention; may be severe, is usually dose related Black Box Warning: Lung cancer: in- creased mortality in those with increased LFTs and a history of platinum-based products Black Box Warning: Hepatic disease: hepatic studies prior to each cycle (bili- rubin, AST, ALT, LDH); check for jaundiced skin and sclera, dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea, if LFTs are >5x upper limit dis- continue • CNS changes: confusion, paresthe- sias, peripheral neuropathy, dysesthesia, pain, weakness; if severe, product should be discontinued or pyridoxine used • VS during first hour of infusion, check IV site for signs of infiltration D Black Box Warning: Hypersensitivity re- actions, anaphylaxis, including hypoten- sion, dyspnea, angioedema, generalized urticaria; discontinue infusion immedi- ately, usually during first or second dose; mild reactions can be treated by slowing infusion, treating symptomatically; do not re-treat in those with severe reactions • Bone marrow depression/bleeding: hematuria, guaiac, bruising or petechiae, mucosa or orifices q8hr; obtain prescrip- tion for viscous lidocaine (Xylocaine); avoid invasive procedures, avoid IM injec- tions, rectal temps if platelets are low • Effects of alopecia on body image; discuss feelings about body changes
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SIDE EFFECTS EENT: Altered hearing, cystoid macular edema CNS: Seizures, fatigue, weakness CV: Fluid retention, peripheral edema GI: Nausea, vomiting, diarrhea, hepa- totoxicity, stomatitis HEMA: Leukopenia, thrombocytopenia, anemia INTEG: Alopecia, nail changes, rash, skin eruptions MISC: Secondary malignancy, Stevens- Johnson syndrome MS: Arthralgia, myalgia, back pain, weakness NEURO: Peripheral neuropathy RESP: Dyspnea, pulmonary edema, fibro- sis, embolism, acute respiratory distress syndrome, interstitial lung disease SYST: Hypersensitivity reactions
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INTERACTIONS Increase: Docetaxel effect—CYP3A inhibi- tors: anastrozole (high doses), aprepitant, fosaprepitant, clarithromycin, conivaptan, delavirdine, efavirenz (induces or inhibits), erythromycin, fluconazole, FLUoxetine, flu- voxaMINE, imatinib, itraconazole, ketocon- azole, nefazodone, voriconazole, and others Increase: modified effect of docetaxel CYP3A inducers: barbiturates, bosentan, carBAMazepine, nevirapine, phenytoin, fosphenytoin, rifabutin, rifampin, rifapentine Increase: myelosuppression—other anti neoplastics, radiation Decrease: immune response—live virus vaccines
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DOSAGE AND ROUTES: • Other regimens are used • Adult: IV 60-100 mg/m2 given over 1 hr q3wk; if neutrophil count is <500 cells/mm3 for >1 wk, reduce dose by 25% Operable node-positive breast cancer, adjuvant • Adult: IV (TAC regimen) 75 mg/m2 1 hr after DOXOrubicin 50 mg/m2 and cyclo- phosphamide 500 mg/m2 q3wk × 6 cycles Locally advanced or metastatic non–small-cell lung cancer D after failure of CISplatin chemotherapy • Adult: IV 75 mg/m2 over 1 hr q3wk; if neutrophil count is <500 cells/mm3 for >1 wk, reduce dose to 55 mg/m2; if pa- tient develops grade 3 peripheral neu- ropathy, stop product Androgen-independent metastatic prostate cancer • Adult: IV 75 mg/m2 given over 1 hr q3wk with 5 mg predniSONE PO bid con- tinuously; give dexamethasone 8 mg PO at 12 hr, 3 hr, and 1 hr prior to DOCEtaxel; if neutrophil count is <500 cells/mm3 for more than 1 wk or other toxicities occur, reduce dose to 60 mg/m2 Squamous cell carcinoma of head and neck • Adult: IV 75 mg/m2 over 1 hr, then CISplatin 100 mg/m2 over 1 hr on day 1, then 5FU 1000 mg/m2/day CONTINUOUS INFUSION × 5 days, repeat cycle q3wk
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Available forms: Injection 10 mg/mL, 20 mg/0.5 mL, 20 mg/mL, 80 mg/2 mL, 80 mg/4 mL; 20, 80 mg powder for injec- tion/vial
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Administer: • Premedicate with dexamethasone 8 mg PO bid × 3 days starting 1 day prior to treatment • Antiemetic 30-60 min prior to product and prn • Confirmation that dexamethasone was given 8 mg bid × 3 days starting 1 day prior to infusion; for prostate cancer give 8 mg 12 hr, 3 hr, and 1 hr prior to infusion • Store prepared solution up to 27 hr in refrigerator Intermittent IV INFUSION route • Use cytotoxic handling procedures • Use non-PVC bag and use non-DEHP tubing • Double-check all orders and products; errors can be fatal • Solution is yellow to brown, do not use if particulate is present • Allow vials to warm to room tempera- ture; withdraw all diluent, inject in vial of DOCEtaxel; rotate gently to mix; allow to stand to decrease foaming, then with- draw the required amount (10 mg/mL), inject in 250 mL of 0.9% NaCl, D5W; mix gently; give over 1 hr Y-site compatibilities: Acyclovir, alfentanil, allopurinol, amifostine, amikacin, amino- caproic acid, aminophylline, amiodarone, amphotericin B lipid complex, ampicillin, ampicillin-sulbactam, anidulafungin, ateno- lol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride/gluconate, CARBOplatin, carmustine, caspofungin, ceFAZolin, cefepime, cefonicid, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cef- TRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxa- cin, cisatracurium, CISplatin, clindamycin, codeine, cyclophosphamide, cycloSPO- RINE, cytarabine, dacarbazine, DACTINo- mycin, DAPTOmycin, dexamethasone, dex- medetomidine, dexrazoxane, diazepam, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOPamine, doripenem, doxacurium, DOXOrubicin HCl, doxycy- cline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, ertapenem, erythromycin, esmolol, etoposide, famoti- dine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, foscarnet, fos- phenytoin, furosemide, ganciclovir, gati- floxacin, gemcitabine, gentamicin, glyco- pyrrolate, granisetron, haloperidol, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, hydrOXYzine, ifos- famide, imipenem-cilastatin, inamrinone, insulin (regular), irinotecan, isoprotere- nol, ketorolac, labetalol, leucovorin, levo- floxacin, levorphanol, lidocaine, linezolid, LORazepam, LR, magnesium sulfate, man- nitol, meperidine, meropenem, mesna, methotrexate, methyldopate, metoclo- pramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, minocycline, mito- XANtrone, mivacurium, morphine, nafcil- lin, naloxone, nesiritide, netilmicin, niCAR- dipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ofloxacin, ondansetron, oxaliplatin, palonosetron, pamidronate, pancuronium, pantoprazole, PEMEtrexed, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phenyleph- rine, piperacillin, piperacillin-tazobactam, polymyxin B, potassium chloride/phos- phates, procainamide, prochlorperazine, promethazine, propranolol, quiNIDine, quinupristin-dalfopristin, ranitidine, remi- fentanil, riTUXimab, rocuronium, sodium acetate/bicarbonate/phosphates, succinyl- choline, SUFentanil, sulfamethoxazole-tri methoprim, tacrolimus, teniposide, theophyl line, thiopental, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trastuzumab, tri- methobenzamide, vancomycin, vasopres- sin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, zidovudine, zole- dronic acid
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Assess:
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Evaluate: • Therapeutic response: decreased tu- mor size, spread of malignancy
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report signs of infection: fever, sore throat, flulike symptoms • To report signs of anemia: fatigue, headache, faintness, SOB, irritability • To report bleeding; to avoid use of razors, commercial mouthwash • To avoid use of aspirin, ibuprofen, al- cohol • That hair may be lost during treat- ment; that a wig or hairpiece may make patient feel better; that new hair may be different in color and texture • That pain in muscles and joints 2-5 days after infusion is common • To avoid receiving vaccinations while taking product • Pregnancy/breastfeeding: to use barrier contraception during and for several months after treatment; to avoid breastfeeding See Appendix B
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PHARMACOKINETICS Metabolized in liver, excreted in feces, half- life 11.1 hr, peak 5-9 days, duration 1 wk
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• Other regimens are used
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• Adult: IV 60-100 mg/m2 given over 1 hr q3wk; if neutrophil count is <500 cells/mm3 for >1 wk, reduce dose by 25% Operable node-positive breast cancer, adjuvant
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• Adult: IV (TAC regimen) 75 mg/m2 1 hr after DOXOrubicin 50 mg/m2 and cyclo- phosphamide 500 mg/m2 q3wk × 6 cycles Locally advanced or metastatic non–small-cell lung cancer D after failure of CISplatin chemotherapy
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• Adult: IV 75 mg/m2 over 1 hr q3wk; if neutrophil count is <500 cells/mm3 for >1 wk, reduce dose to 55 mg/m2; if pa- tient develops grade 3 peripheral neu- ropathy, stop product Androgen-independent metastatic prostate cancer
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• Adult: IV 75 mg/m2 given over 1 hr q3wk with 5 mg predniSONE PO bid con- tinuously; give dexamethasone 8 mg PO at 12 hr, 3 hr, and 1 hr prior to DOCEtaxel; if neutrophil count is <500 cells/mm3 for more than 1 wk or other toxicities occur, reduce dose to 60 mg/m2 Squamous cell carcinoma of head and neck
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• Adult: IV 75 mg/m2 over 1 hr, then CISplatin 100 mg/m2 over 1 hr on day 1, then 5FU 1000 mg/m2/day CONTINUOUS INFUSION × 5 days, repeat cycle q3wk
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