Docetaxel Disease Interactions

Because of their cytotoxic effects on rapidly proliferating tissues, antineoplastic agents frequently can, to varying extent, induce myelosuppression. The use of these drugs may be contraindicated in patients with known infectious diseases. All patients should be instructed to immediately report any signs or symptoms suggesting infection such as fever, sore throat, or local infection during antineoplastic therapy. Close clinical monitoring of hematopoietic function is recommended.

Severe fluid retention characterized by peripheral edema, generalized edema, pleural effusion, dyspnea at rest, cardiac tamponade, or abdominal distention due to ascites has been reported during docetaxel therapy. Therapy with docetaxel should be administered cautiously to patients adversely affected by fluid retention. Prophylaxis with a five day dexamethasone premedication regimen is recommended, however, fluid retention has occurred despite this pretreatment.

Cystoid macular edema has been reported with the use of docetaxel. Patients with impaired vision should undergo a prompt and comprehensive ophthalmologic examination prior to therapy with this agent. If cystoid macular edema is diagnosed, treatment should be discontinued and appropriate treatment initiated. Alternative non-taxane cancer treatment should be considered.

Docetaxel is extensively metabolized by the liver. Total body clearance of docetaxel has been reported to be reduced as much as 27% in patients with mild to moderate hepatic impairment resulting in a 38% increase of docetaxel serum concentration. Patients with elevated transaminase levels (>1.5 times the upper limits of normal) and alkaline phosphatase (>2.5 times the upper limits of normal) should not be administered docetaxel. The incidence of docetaxel related deaths is increased in patients with impaired hepatic function. Bilirubin, transaminase, and alkaline phosphatase levels should be obtained prior to each cycle of docetaxel therapy. Patients with combined abnormalities of transaminases and alkaline phosphatase should not be treated with this agent.

The use of docetaxel is contraindicated in patients with a neutrophil count < 1500/mm3. Docetaxel induces dose-related myelosuppression resulting in neutropenia, thrombocytopenia, and anemia. Neutropenia occurs in all patients administered 60-100 mg/m2 of docetaxel. Grade 4 neutropenia (< 500/mm3) occurs in nearly all patients administered 100 mg/m2 of docetaxel. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, or local infection. Therapy should be administered cautiously to patients with compromised bone marrow reserve and should be withheld until neutrophil levels is > 1500/mm3 and/or platelet counts is > 100,000/mm3. A 25% reduction in dosage is recommended during subsequent cycles following severe neutropenia (< 500/mm3). It is recommended to performed frequent blood cell counts on all patients receiving docetaxel.

The alcohol content in a dose of docetaxel injection may affect the central nervous system. Cases of intoxication have been reported with some formulations of docetaxel due to the alcohol content. Close monitoring is recommended in alcoholic patients. Consideration should be given to the alcohol content in docetaxel injection on the ability to drive or use machines immediately after the infusion.

Severe neurosensory symptoms such as paresthesia, dysesthesia, and pain have been reported during docetaxel therapy. Therapy with docetaxel should be administered cautiously to patients with or predisposition to neurosensory symptoms. Although reversible with discontinuation of docetaxel therapy, the dosage must be adjusted if neurosensory symptoms occur and therapy discontinued if symptoms persist.