Docetaxel

Docetaxel is an anticancer drug belonging to the family of antimitotic agents.

Docetaxel - Chemical Structure

Docetaxel is a semisynthetic taxane derived from the natural molecule paclitaxel (also an anticancer agent). Paclitaxel was first isolated from Taxus brevifolia, a conifer from North America.

Indications

For what it uses

The use of docetaxel is indicated for the treatment of the following diseases:

Early and advanced breast cancer;
Lung cancer;
Prostate cancer;
Metastatic stomach cancer;
Head and neck cancer.

Warnings

Docetaxel should only be administered by specialized personnel under the strict supervision of the oncologist.

Before every docetaxel administration blood samples must be taken to check that the concentration of blood cells is sufficiently high. In addition, checks must be performed to verify liver function.

Due to the toxicity of docetaxel on the eyes, eye checks should be performed.

Patients should undergo corticosteroid-based preventive therapy before starting treatment with docetaxel. This pre-treatment is necessary to prevent the occurrence of certain side effects, in particular, to prevent allergic reactions and water retention.

Since docetaxel can cause dizziness - if such symptoms appear - driving vehicles and / or using machines is not recommended.

Interactions

Drug interactions may occur following the concomitant use of docetaxel and drugs capable of inhibiting or competing with hepatic cytochrome P3A4 enzymes. Examples of these drugs are:

Ciclosporina, an immunosuppressive drug used in the prevention of transplant rejection;
Terfenadine, an antihistamine drug;
Antifungal drugs, such as - for example - ketoconazole ;
Erythromycin and troleandomycin, antibiotic drugs.

It is, however, necessary to inform your doctor if you are taking - or have recently been taken - drugs of any kind, including over-the-counter drugs and herbal and cosmetic products.

Side effects

Docetaxel can induce different types of side effects that can vary from individual to individual by type and intensity.

If docetaxel is given in combination with other anticancer medicines, the severity of adverse effects may increase.

The following are the main side effects that may occur following docetaxel therapy.

Myelosuppression

Docetaxel can induce myelosuppression, ie it is able to suppress bone marrow activity. This suppression causes a decrease in the production of blood cells which can lead to:

Anemia (decrease in hemoglobin blood levels), the main symptom of the onset of anemia is the feeling of physical exhaustion;
Leukopenia (decrease in white blood cell levels), with increased susceptibility to contraction of infections;
Plateletopenia (decrease in the number of platelets), this leads to the appearance of bruising and abnormal bleeding with an increased risk of bleeding.

Gastrointestinal disorders

Treatment with docetaxel can cause nausea, vomiting and diarrhea.

Vomiting can occur from a few hours to a few days after taking the drug and can be controlled by using anti-emetic drugs.

Diarrhea, on the other hand, can be treated with anti-diarrheal drugs. In any case, it is necessary to drink a lot to replenish lost fluids.

In addition, esophagitis, pain and difficulty in swallowing, abdominal pain, constipation, difficulty in digesting, inflammation of the small and / or colon intestine and intestinal perforation may occur.

Oral cavity disorders

Docetaxel therapy can promote the development of oral cavity ulcers, inflammation of the mouth, dry mouth and pain. To try to prevent these symptoms, take plenty of fluids and clean your teeth regularly with a soft toothbrush.

A temporary loss of the sense of taste that is usually regained at the end of therapy may also arise.

Alopecia

Docetaxel can cause hair and hair loss in general. This side effect generally disappears after the end of the treatment.

Allergic reactions

Docetaxel can trigger allergic reactions in sensitive individuals. These reactions occur in the form of hot flushes, skin reactions, itching, tightness in the chest, difficulty in breathing, fever, chills, back pain, decreased blood pressure.

Nervous system disorders

Docetaxel treatment can cause dizziness, insomnia, numbness or tingling in joints and / or muscles and headache.

Eye disorders

Docetaxel therapy can cause visual disturbances and increased lacrimation.

Cardiovascular disorders

Docetaxel can cause decreased blood pressure, irregular or accelerated heart rate and heart failure.

Respiratory disorders

Docetaxel treatment can cause shortness of breath, cough, lung inflammation with difficulty breathing and coughing, interstitial pneumonia and pulmonary fibrosis.

Other side effects

Other side effects that may arise following docetaxel therapy are:

Temperature;
Anorexia;
Edema;
Flu-like symptoms;
A runny nose;
Inflammation of the throat and nose;
Nose bleeding;
Redness and swelling of the palm of the hands and the soles of the feet;
Chromatic variations of the nails that can also come off;
Myalgia;
arthralgia;
Fatigue;
Edema;
Increase or loss of body weight;
Oral candidiasis;
Dehydration;
Hearing changes;
Increased levels of liver enzymes in the bloodstream;
fainting;
Phlebitis (inflammation of the veins);
Blood clot formation;
Hyponatremia (decrease in blood concentration of sodium).

Overdose

Since docetaxel can only be administered by highly specialized personnel, it is very unlikely that cases of overdosing will occur.

Action mechanism

Docetaxel is an antimitotic agent. More specifically, docetaxel is a promoter of tubulin polymerization.

Antimitotic agents act during cell division ( mitosis ), in particular, in the phase in which the newly synthesized DNA must divide between the two daughter cells. The breakdown of the genetic material takes place thanks to the mitotic spindle, a complex structure consisting of microtubules. The microtubules are - in turn - structures that are formed following the polymerization of a particular protein called tubulin.

Docetaxel binds to the tubulin which constitutes the microtubules, stabilizing them and thus preventing their disassembly. In this way, a morphological alteration is created which leads the cancer cell to undergo apoptosis (a mechanism of programmed cell death).

Mode of Use - Posology

Docetaxel is available for intravenous administration in the form of a viscous yellow-brown liquid which - once diluted - appears as a clear solution.

The administration can take place through three different ways:

Through a cannula (a thin tube) that is inserted into a vein of an arm or hand;
Through a central venous catheter that is inserted subcutaneously into a vein near the clavicle;
Through the PICC line (Peripherally Inserted Central Catheter), in this case, the catheter is inserted into a peripheral vein, usually of an arm. This technique is used for the administration of anticancer drugs for a prolonged time.

The docetaxel dosage must be established by the doctor on an individual basis, depending on the type and degree of the pathology to be treated and according to the body weight and the patient's health conditions.

The doctor will calculate the body surface area in square meters (m2) and determine the dose of medication that the patient will have to take.

Pregnancy and breastfeeding

Docetaxel is teratogenic, therefore pregnant women should not take the drug. Furthermore, precautions must be taken to avoid the onset of possible pregnancies.

Men should also not procreate, either during or after treatment with docetaxel, for a period of at least six months.

Breast-feeding mothers should not take docetaxel.