DOCETAXEL

DOCETAXEL
(doc-e-tax'el)
Taxotere
Classifications: antineoplastic agent; taxane agent;
Therapeutic: antineoplastic
Prototype: Paclitaxel
Pregnancy Category: D

Availability

20 mg, 80 mg injection

Action

Docetaxel is a semisynthetic analog of paclitaxel. Potential advantages over paclitaxel are greater antitumor activity and lower toxicity potential. Docetaxel, like paclitaxel, binds to the microtubule network essential for interphase and mitosis of the cell cycle.

Therapeutic Effect

Docetaxel stabilizes the microtubules involved in cell division and prevents their normal functioning; this results in inhibiting mitosis in cancer cells.

Uses

Metastatic breast cancer, metastatic prostate cancer, non-small cell lung cancer.

Contraindications

Hypersensitivity to docetaxel or other drugs formulated with polysorbate 80, paclitaxel, neutrophil count <1500 cells/mm³, biliary tract disease, hepatic disease, jaundice, neutropenia, intramuscular injections, thrombocytopenia, lactation, pregnancy (category D), acute infection.

Cautious Use

Bone marrow suppression, bone marrow transplant patients; CHF, ascites, peripheral edema, pleural effusion; radiation therapy; pulmonary disorders, acute bronchospasm; cardiac tamponade; dental disease, dental work, herpes infection; hypotension, elderly; infection. Safety and effectiveness in children <16 y are not established.

Route & Dosage

Breast Cancer
Adult: IV 60–100 mg/m² every 3 wk (premedicate patients with dexamethasone 8 mg b.i.d. x 5 d, starting 1 d prior to docetaxel)

Prostate Cancer
Adult: IV 75 mg/m² every 21 d plus prednisone (5 mg PO twice daily) for 10 cycles (premedicate patients with dexamethasone 8 mg q12h, 3h, and 1h prior to starting docetaxel infusion)

Non-Small Cell Lung Cancer
Adult: IV 75 mg/m² every 3 wk

Administration

Note: If drug contacts skin during preparation, wash immediately with soap and water.

Intravenous

PREPARE: IV Infusion: ??Bring vials to room temperature for 5 min; add provided diluent, gently rotate for 45 sec; let stand until surface foam dissipates.??Inject required amount of diluted solution into a 250-mL, or larger, bag of NS or D5W; the final concentration should be between 0.3–0.74 mg/mL. Mix completely by manual rotation.??Use glass or polypropylene bottles or polypropylene or polyolefin plastic bags and administer through polyethylene-lined administration sets. Do not use PVC administration sets or containers. ??Mix completely by manual rotation.??Use within 4 h (including the 1 h infusion time).

ADMINISTER: IV Infusion: ??Give at a constant rate over 1 h. Administer ONLY after premedication with corticosteroids to prevent hypersensitivity.??Reduce dose by 25% following severe neutropenia (<500 cells/mm³) for 7 d or longer for febrile neutropenia, severe cutaneous reactions, or severe peripheral neuropathy.

INCOMPATIBILITIES Y-site: Amphotericin B, doxorubicin, methylprednisolone, nalbuphone.

Refrigerate vials at 2°–8° C (36°–46° F). Protect from light. Do not store in PVC bags. Store diluted solutions in refrigerator or at room temperature for 8 h.

Adverse Effects (≥1%)

CNS: Paresthesia, pain, burning sensation, weakness, confusion. CV: Hypotension, fluid retention (peripheral edema, weight gain), pleural effusion. GI: Nausea, vomiting, diarrhea, stomatitis, abdominal pain; increased liver function tests (AST or ALT). Hematologic: Neutropenia, leukopenia, thrombocytopenia, anemia, febrile neutropenia. Skin: Rash, localized eruptions, desquamation, alopecia, nail changes (hyper/hypopigmentation, onycholysis). Body as a Whole: Hypersensitivity reactions, infusion site reactions (hyperpigmentation, inflammation, redness, dryness, phlebitis, extravasation).

Interactions

Drug: Possibility of interacting with other drugs metabolized by CYP3A4.

Pharmacokinetics

Distribution: 97% protein bound. Metabolism: In liver by CYP3A4. Elimination: 80% in feces, 20% renally. Half-Life: 11.1 h.

Nursing Implications

Assessment & Drug Effects

Lab tests: Monitor bilirubin, AST or ALT, and alkaline phosphatase prior to each drug cycle. Generally, do not give to patients with elevations of bilirubin or with significant elevations of transaminases concurrent with elevations of alkaline phosphatase. Monitor frequently CBCs with differential. Withhold drug if platelets <100,000 or neutrophils <1500 cells/mm³.
Monitor for S&S of hypersensitivity (see Appendix F), which may develop within a few minutes of initiation of infusion. It is usually not necessary to discontinue infusion for minor reactions (i.e., flushing or local skin reaction).
Assess throughout therapy and report cardiovascular dysfunction, respiratory distress; fluid retention; development of neurosensory symptoms; severe, cutaneous eruptions on feet, hands, arms, face, or thorax; and S&S of infection.

Patient & Family Education

Learn common adverse effects and measures to control or minimize them when possible. Report immediately any distressing adverse effects.
Note: It is extremely important to comply with corticosteroid therapy and monitoring of lab values.
Avoid pregnancy during therapy.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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