Taxotere Side Effects

Like many other chemotherapy drugs used to fight cancer, Taxotere causes several side effects that negatively affect the quality of life during treatment. An agent from the taxane class, docetaxel is an anti-mitotic medicine that disrupts cellular division. The U.S. Food and Drug Administration (FDA) approved it as a second-line treatment of non-small cell lung cancer, breast cancer, metastatic prostate cancer, head and neck cancer, and advanced stomach cancer. Chemotherapy mostly targets all the cells that replicate at higher rates throughout the body, so it kills tumor cells while they spread (metastasis) as well as any other fast-growing ones. Because of that, this drug interferes with the duplication of hair follicles, blood cells, the immune system and many other districts, with adverse reactions reported in up to 90 percent of patients treated. Taxotere level needs constant monitoring because of its serious toxicity. If its levels become too high, a patient may suffer catastrophic or even fatal consequences.

General considerations

This is not a complete list of possible adverse reactions and it’s always advisable to discuss your problems with your healthcare provider to manage your symptoms throughout and after your therapy. Due to its mechanism of action, several Taxotere side effects are more common than others. An effect is described as “common” when it affects more than 10-30 percent of patients, although many of those caused by this drug occur in more than 60 percent of subjects treated (sometimes even over 95 percent). However, people do not experience all those symptoms at the same time, and there are many therapeutic options to prevent or, at least, minimize them since they are often predictable. Except for a few ones such as the dreaded permanent alopecia, most adverse reactions are temporary, and patients can return to normal life after treatment is complete (sometimes up to one year later). Side effects’ severity is strictly dependent on the drug dosage (higher doses produce more severe unwanted reactions), but there is no relationship between their severity and the medication’s effectiveness. Using docetaxel along with other chemotherapy agents can usually further increases the risk and duration of its adverse reactions.

Anemia and bleeding

Chemotherapy reduces the bone marrow’s ability to produce new red blood cells, causing anemia as well as a decrease in the number of platelets (thrombocytopenia). A low red blood cell count may cause dizziness, fatigue, shortness of breath and pale skin and can be managed by limiting the intake of alcohol or caffeine, avoiding physical exertion, drinking plenty of fluids and getting more sleep at night. Thrombocytopenia increases the risk of bleeding and hemorrhages and requires additional precautions such as using an electric razor, using protective gloves when using gardening tools or scissors, and avoiding contact sports that could cause injuries. Anemic patients should constantly be monitored to check their blood cell counts or when unusual bleedings occur. A patient should seek immediate medical attention if weakness or lightheadedness become more severe, if he has difficulty breathing, or if tachycardia or chest pain occur. In some instances, a physician may prescribe erythropoietin (EPO) to boost red blood cells’ growth or a transfusion may be needed.

Neutropenia and leukopenia

Taxotere can also decrease or suppress the production of white blood cells (WBC) such as leukocytes (leukopenia) or neutrophils (neutropenia). This type of hematologic reaction is one of the most common side effects of this medication, and occur in almost 75 percent of patients treated. Since white blood cells constitute the immune system, the risk of infection in neutropenic or leukopenic patients may be high. A low WBC count may mask common symptoms of infections such as nasal drainage, sputum, swelling or pus, so patients should always be alert to any subtle change of their health such as chills or an increased body temperature. Neutropenic patients are prone to recurrent or chronic infections in the urinary tract, mouth, throat and ears. To minimize the risks, it is recommended for patients to avoid crowded places or people with colds or other contagious diseases, and to immediately report any sign of infection such as fever to their physicians. Other useful recommendations include avoiding contact with sick people or pets, do not undergo dental surgery while WBC count is low, and keeping the hands and household as clean as possible with frequent washing.

Nerve and muscle problems

Side effects of Taxotere include nerve and muscle issues such as peripheral neuropathy, myalgia or arthralgia which may require years before they subside. Symptoms of chemotherapy-induced neurological problems can include tingling or burning sensations, numbness, shaking, hearing loss, pain in the limbs, joints, back or abdomen and weakness. Most of these effects are mild and do not require medical attention, although they may still negatively affect a patient’s quality of life since he may have difficulties clothing or picking up objects, frequently lose his balance, and get tired very quickly. Getting plenty of rest is usually the simplest way to get some relief, but a doctor may also prescribe supportive therapy with pain relievers or other medications.

Gastrointestinal issues

Chemotherapy drugs are associated with several gastrointestinal issues such as diarrhea, constipation, weight loss, nausea and vomiting. It is advised to contact a health care provider if diarrhea or vomit persist for several days, occur more than 4-5 times in a 24-hour period or if stools are black, tarry or contain blood. A doctor may prescribe a specific treatment to assist in reducing the symptoms including intravenous (IV) fluid replacement or medications such as loperamide. Over-the-counter (OTC) medicines should never be taken without asking a doctor.

Chemotherapy-induced nausea and vomiting are common side effects and can be very severe. To help relieve these symptoms it is advisable not to eat before the infusion, and to eat small, frequent meals over the course of the day. If these effects persist or worsen, a physician may prescribe an antiemetic drug such as Zofran (ondansetron). If nausea is caused by anxiety about chemotherapy, some benzodiazepines such as diazepam or lorazepam may help lessen this effect. Maintaining a proper nutrition and drinking plenty of fluids are of paramount importance to avoid facing more serious consequences such as dehydration, electrolyte imbalance and malnourishment.

Hair Loss

Hair loss is one of the most common side effects associated with chemotherapy due to the high replication rates of the hair follicle epithelium. After three or four weeks since the beginning of treatment, hair start becoming thin, dry and dull until, in some instances, it falls out gradually or in clumps. The head can become sensitive or itchy, and the hair loss may occur in other parts of the body such as eyebrows, legs, armpits and eyelashes. After the therapy is over, hair follicles will eventually repair themselves and grow back within a few months (usually between three and six), although it may be f a different texture or color. Baldness can negatively affect a person’s self-esteem and body image, leading to more severe consequences such as depression or anxiety, especially in women. In order to cope with the stress, anger or sadness, some people feel more comfortable by wearing scarves, hairpieces, wigs or caps.

In many instances, however, the hair loss can be irreversible after treatment with docetaxel. Several studies found convincing evidence of a link between this drug and a condition known as Persistent Chemotherapy-Induced Alopecia. Patients affected by this permanent form of baldness cannot grow their hair back even after treatment with substances that help rapid regrowth such as minoxidil, spironolactone and vitamins. Although in Europe the regulatory agencies acknowledged this risk back in 2005, the FDA only issued a label change to warn the public about the danger of irreversible alopecia only in late 2015.

Mouth sores

Docetaxel may also cause painful sores in the mouth or throat known as stomatitis or mucositis as well as increase the risk of getting cavities. Due to the high capacity for renewal of the oral epithelium, these tissues are especially affected by the antimitotic effects of the drug and may become dry, irritated or start bleeding. The inflammation process can also cause ulcers painful enough to interfere with a person’s ability to sleep, talk and eat. Pain can be managed with opioids such as fentanyl buccal tablets or patches. To lessen these symptoms a dentist may suggest a fluoride gel or rinse and a special toothpaste for sensitive gums. Teeth should be brushed after every meal with a soft toothbrush, and gums should be rinsed with warm water mixed with salt or baking soda before bedtime. Good oral care is important as much as eating regularly to reduce the risk of getting mouth sores.

Fluid retention

Fluid retention may occur due to an increased permeability of the capillaries and a generalized failure of the lymphatic system. Its symptoms include swelling of the hands, feet, face or abdomen (peripheral edema), and are generally lessened by administering dexamethasone for three days before the infusion. Dietary restrictions such as a low-sodium diet or avoiding foods with high amount of salts may help relieve the symptoms. Severe cases may need treatment with a diuretic drug to avoid fluid accumulation in the lungs which may lead to cardiovascular problems.

Skin toxicity

Skin toxicity is usually reversible and occurs as cutaneous reactions such as rashes, localized eruptions and erythema of the extremities. These reactions are associated with edema, desquamation and pruritus and are usually localized on the feet and hands, but have also been observed on the thorax, face and arms. Eruptions generally manifest within one week after docetaxel infusion and are not disabling. Avoiding sun exposure and keeping the skin hydrated may help relieve these symptoms. Temporary nail discoloration or hyperpigmentation has also been observed, and in some extreme cases, nails even may fall off.

Alcohol intoxication

Since some formulations of this agent contain substantial amounts of ethanol, patients may experience symptoms of alcohol intoxication during or after treatment. Subjects should avoid performing potentially dangerous activities such as operating machinery or driving vehicles for at least two hours after the infusion, regardless of whether they feel drunk or not. A danger of interaction which may worsen the alcohol intoxication is present with some medicines such as sleep aids or pain relievers. The drunkness may be transient, and different docetaxel formulation with lower alcohol content could be used to reduce this risk. It is usually recommended to avoid drinking alcoholic beverages which may further exacerbate the problem.

Pregnancy Risk

use contraceptive methods to avoid conceiving a child while taking this taxane, although women who are already pregnant at the moment of the diagnosis must be advised of the potential risks to the baby. Fetal malformations caused by this agent include cerebral birth defects and gastric stenosis. Breastfeeding is also not recommended during treatment since the medication may be transferred into human milk. Once the therapy is concluded, a patient should discuss with her doctor when she may safely become pregnant.

Allergic reactions and hypersensitivity

Severe hypersensitivity reactions have been reported. Since they may be fatal, allergic reactions must be treated as a medical emergency and require immediate discontinuation of the infusion. Most severe symptoms happen rarely, usually during the first two infusions, and include hypotension, generalized erythema, throat and tongue swelling, bronchospasm and anaphylaxis. Minor events include back pain, rash, drug fever, flushing and chills and can be resolved with an appropriate therapy. Premedication with oral corticosteroids taken one day before the docetaxel infusion may help reduce the risk and severity of hypersensitivity reactions. Mild and uncommon infusion site reactions consisting of redness and inflammation of the vein and skin have also been reported.