


<b> Docetaxel                 Taxotere(r)   </b>  



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General Considerations

Descriptive Information

Side Effects

Online Information for Patients

Clinical Trial Results and Information Searches




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<b>General Considerations</b>

It is possible to get a severe reaction after taxotere that involves difficulty breathing and/or cardiac arrhythmias.   Allergic reactions may occur during docetaxel administration; you will receive medication before each treatment to help prevent these reactions. With these preventive       medications, these allergic reactions are uncommon. You should be watched carefully during the initial part of the infusion to treat these effects if they occur. If you experience any of the      following symptoms after a Taxotere infusion, call your doctor immediately AND seek medical attention:
: 
shortness of breath, 
facial flushing, 
fever, 
chest pain, 
dizziness, lightheadedness, 
or skin rash.

The Docetaxel  [Taxotere] + Gemcitabine combination is tolerable and highly active in LMS, with response rates [including stable disease] of up to over 50%. [Maki, MSKCC]  PMID: 12065559
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12065559&dopt=Abstract 


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<b>Descriptive Information   </b>

Docetaxel is in a class of chemotherapy agents known as taxanes.  It is a yellow/brown liquid, which forms a clear solution when diluted, and  is given by intravenous infusion.

            
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<b>Before Use  --- Tell Your Doctor:</b>

Allergies-if you have ever had any unusual or allergic reaction to docetaxel or any other medicine or substance.

Tell your doctor what prescription and nonprescription medications you are taking, including vitamins, herbals, supplements.  And especially if you take aspirin, cyclosporine, erythromycin,  ketoconazole, or troleandomycin.  

Tell your doctor if you have or have ever had liver or kidney disease [There is a much increased chance of serious side effects.].  If you have ever been treated with x-rays or cancer medicines. If you have other medical problems, especially alcohol abuse or history of alcohol abuse in the past. [The risk of some side effects affecting the   muscles and nerves may be increased]

Chickenpox (including recent exposure) or Herpes zoster (shingles) [There is a risk of severe       disease spreading to other parts of the body]
  
Fluid in lungs.  [Docetaxel may make your condition worse]
Infection  [Docetaxel may decrease your body's ability to fight infection]

Pregnancy-if you are pregnant or if you intend to become pregnant. Be sure to discuss fertility, breastfeeding, and birth control with your doctor prior to starting treatment.  Tell your doctor right away if you think you have become pregnant during treatment.  Docetaxel may stop periods in women, or sperm production in men, but you should not assume that pregnancy might not occur.  You should not plan to have children when being treated with chemotherapy, or for some time after the treatment is stopped.  Use reliable birth control, docetaxel can harm the fetus, discuss with your doctor.
 
Breast-feeding-It is not known whether docetaxel passes into breast milk. Breast-feeding is generally not recommended while you are receiving it.

The Elderly -This medicine has been tested in older adults and has not been shown to cause different side effects or problems than it does in younger adults.

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<b>INTERACTIONS with other medication:</b>

If you are being treated with docetaxel, tell your doctor if you taking any of these medicines:

  Amphotericin B by injection (e.g., Fungizone)  
  Antithyroid agents (medicine for overactive thyroid)  
  Azathioprine (e.g., Imuran)  
  Chloramphenicol (e.g., Chloromycetin)  
  Colchicine  
  Flucytosine (e.g., Ancobon)  
  Ganciclovir (e.g., Cytovene)  
  Interferon (e.g., Intron A, Roferon-A)  
  Plicamycin (e.g., Mithracin)  
  Zidovudine (e.g., AZT, Retrovir)  
  Erythromycins (medicine for infection)  
  Ketoconazole (e.g., Nizoral)  
  Midazolam (e.g., Versed)  
  Orphenadrine (e.g., Norflex)  
  Testosterone (male hormone)  
  Troleandomycin


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<b>Side Effects </b>

<b>Bone marrow suppression: </b>low white cells, red cells and/or platelets.  This can cause           anemia, risk of bruising or bleeding and infection. This effect can begin about 7 days after the treatment has been given and usually reaches its lowest point at 10-14 days after the chemotherapy. The blood count then increases steadily and usually returns to normal within 3 weeks.
   
The extent to which blood counts are reduced depends upon the dose of the chemotherapy agent or agents given.  Blood counts are done regularly.

If your temperature rises above 38 C or 100.5 F, or you develop bruising or bleeding, or if you suddenly feel unwell, call your doctor immediately.
            
<b>Nausea and vomiting.</b> This is usually mild. There are now very effective anti-vomiting drugs to prevent or substantially reduce nausea and vomiting [Zofran or Kytril].  Let your doctor know if you are feeling nauseated or are vomiting.


<b>Mouth sores and ulcers.</b> If your mouth becomes sore, or you notice small ulcers, let your doctor know. They can prescribe suitable mouth care for you.   Magic Mouthwash is a combination of local anesthetic and some other soothing agents.  It helps a lot, too.


<b>Diarrhea. </b>Often controlled with Lomotil or similar agents, but notify your doctor if it is severe or persistent.  Drink plenty of liquids.
 
<b>Hair loss. </b>This usually starts 2-3 weeks after treatment starts, although it may occur earlier. Hair may be lost  completely or may just thin. You will probably also experience thinning or loss of eyelashes, eyebrows and other body hair. This is temporary: 

<b>Skin changes.</b> Docetaxel can cause a rash. It can also cause palms of the hands and soles of the feet to become sore and red.  [Plantar-Palmar Dysesthesia]  This goes away when treatment stops.
 
<b>Allergic reactions.</b> Symptoms can be: skin rashes and itching, high temperature, shivering, redness of the face, a feeling of dizziness, headache, shortness of breath, anxiety and a need to pass urine. You will be watched for symptoms of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these symptoms.  Check Blood Pressure Readings.

A course of steroids is often prescribed to reduce the chance of developing an allergic reaction 
and to help reduce other side effects. 

<b>Fatigue and  weakness. </b>Rest!  Have your blood counts checked.
 
<b>Fluid retention.</b> Swelling ankles, legs, hands, and weight gain can occur, and will remit once you stop treatment.  Diuretics might be given before the infusion in order to limit the fluid retained.
            
<b>Numbness or tingling in hands or feet</b>. This is peripheral neuropathy caused by the docetaxel. 
Tell your doctor.  This will improve slowly once treatment is stopped. 

<b>Changes in nails. </b>The color of your nails may change but will grow out once the drug is stopped.  Pain in the nail bed is rare. 

<b>Pain in joints or muscles</b>  Tell your doctor so painkillers can be prescribed.

<b>Fertility, Contraception, Breast Feeding:</b>  this drug can render you infertile, it might cause a miscarriage or damage to a fetus.  Discuss contraception with your doctor.  Tell your doctor if you have gotten pregnant or fathered a child while under this treatment.

If there is <b>Redness, pain, burning or swelling around the vein</b> while the drug is being given, or any leakage from the Intravenous setup-<b>TELL THE NURSE IMMEDIATELY</b>.  The solution is caustic and will damage and scar when it comes in contact with your arm.
            

<b>Rare Side Effects: But Contact your doctor immediately should one of these occur:
chest pain
fast or irregular heartbeat
shortness of breath  


Long Term Side Effects of This Medicine</b>

Chemotherapy agents might cause other unwanted effects that may not occur until months or years after the medicine is used. These delayed effects may include certain types of cancer. Discuss these possible effects with your doctor.


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<b>While you are being treated:

See your doctor regularly.
 
Watch for an Infection problem:</b>
Docetaxel can temporarily lower the white cells in your blood so that you do not fight off infections.

Do not have any vaccinations without your doctor's approval.
Avoid people with infections, and do not be around anyone who has taken oral polio vaccine within the last several months.   Contact your doctor immediately if you think you have an infection, or have fever, or chills, or cough, or hoarseness, or low back pain, side pain, or painful/difficult urination.  Be careful when brushing teeth, check with your doctor or dentist.
 
Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.  Do not manicure the skin around the nail bed, or trim nails, during the time when your white cell counts are low.


<b>Watch for a Bleeding problem:</b>
Docetaxel can also temporarily loser the number of platelets in your blood, too.
Contact your doctor immediately if you notice any unusual bleeding or   bruising; black, tarry stools; blood in urine or stools; or pinpoint red spots on your skin. 
Avoid situations like contact sports where bruising or injury might occur.  Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters. 


<b>Take your Medication Properly</b>

Docetaxel often causes nausea and vomiting, and this can be well controlled with taking anti-emetics like<b> Kytril or Zofran.</b>  They must be taken ON SCHEDULE, and you must not forget to take them.
Your doctor may direct you to take a<b> corticosteroid </b>tablet such as dexamethasone (Decadron), starting the day before you receive an injection of docetaxel and continuing for a few days after a docetaxel treatment. The corticosteroid decreases the chance of an allergic reaction to docetaxel and helps with some of the other side effects. It is very important that you take each dose of the corticosteroid medicine as directed.

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Keep all medicines out of the reach of children.

<b>In case of overdose, call your local poison control center at 1-800-222-1212. If the victim has collapsed or is not breathing, call local emergency services at 911.</b>


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<b>Online Information for Patients</b>


Taxotere  Docetaxel

http://www.cancerbackup.org.uk/info/taxotere.htm 

http://www.taxotere.com/pi/ 

http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a696031.html

http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202920.html

http://www.cancersource.com/Resources/drugguide/index.cfm?DiseaseID=1

http://www.bchealth.com/services/cancer/drugs/taxot.htm




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<b>Clinical Trial Results


The Clinical Trials results are the experiments done in the past to see if the drug works, and how well, and for how long. 


PubMed Searches
Directions for use:

When you click on the search string, it will connect you to Pubmed and display the first 20 citations [which they will call Summaries].  What you WANT is the complete listing of all the summaries of the article [which they will call Abstracts. ]  

Go to the second toolbar, and use the drop down menu to change summaries to Abstracts,  and 20 to 200,  and sort by DATE, and then click on DISPLAY on that same toolbar.  You may have to wait while the page loads.

NOW you can save this search to a folder on your hard drive as "Docetaxel Clinical Trials" as an HTML file - or as a text file.  The entire file, or just those parts which you wish to discuss, can be printed out and taken to talk over with your doctor.</b>



Clinical trial Results and LMS and taxotere
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=PubMed&term=clinical%20trial%20AND%20leiomyosarcoma%20AND%20taxotere   

Clinical trial results and sarcoma and taxotere
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=PubMed&term=clinical%20trial%20AND%20sarcoma%20AND%20taxotere   

Taxotere + gemcitabine
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=PubMed&term=taxotere%20AND%20gemcitabine 

Taxotere - all the medical literature in Pubmed
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=PubMed&term=taxotere  



<b>ASCO Searches</b>
http://www.asco.org
You will have to go to the site and search the abstracts with keywords of the chemotherapy agent AND sarcoma.  It is an excellent site for results of clinical trials of new agents.
<b>http://www.asco.org/ac/1,1003,_12-002328,00.asp 
http://www.asco.org/prof/me/html/01abstracts/toc.htm</b>


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compiled by doctordee

March 2003


