Chemotherapy is the treatment of a disease, including cancer, with any type of toxic chemical. Chemotherapy is designed to kill fast dividing cells (cancer divides more quickly than normal cells); however the drug cannot discriminate against normal cells so numbers of them will also die. Your hair and nails are the fastest dividing normal cells in your body so they are the most visible cells to be affected, along with the cancer cells themselves, by chemotherapy. Treatment of prostate cancer via chemotherapy almost always employs the drugs docetaxel (Taxotere) and cabazitaxel (Jevtana), which are the only FDA approved chemotherapy drugs. However, in some instances where an individual has not ben able to use docetaxel, the breast cancer drug taxol can be used “off FDA label”.
The US Food and Drug Administration (FDA) approved Taxotere (docetaxel) in May 2004 for men with castrate resistant, metastatic disease. Taxotere is administered by intravenous infusion (IV) in combination with the steroid prednisone, every three weeks. Men who experience significant side effects will have a reduced Taxotere dosage administered every week. The higher dosage infusions are considered to be more effective, but the lower dose also works.
Taxotere demonstrated safety and effectiveness in the TAX327 clinical trial of more than 1,000 men, as compared to the previous standard of care for men with castrate resistant prostate cancer who had bone metastases. In this trial, Taxotere provided a mean survival advantage of 2.5 months over the control group receiving the previous standard of care, mitoxantrone.
Taxotere chemotherapy is systemic, meaning it works throughout your entire body. Taxotere targets and kills rapidly dividing cells. Since cancer cells divide more quickly than healthy cells, more cancer cells are killed by the drug than are healthy cells. Taxotere will also kill healthy cells including the normally more rapidly dividing skin, hair follicle, gastrointestinal tract, and bone marrow cells.
Taxotere is administered by infusion together with a steroid such as prednisone or dexamethasone. These steroids are administered because Taxotere interferes with the adrenal production of corticoid-steroids and therefore need to be replaced. Additionally, steroids can control allergic reactions to the drug or its preservatives, prevent nausea and vomiting, help lower blood calcium levels in men with bone metastases and reduce inflammation.
Some men (very uncommon) may experience extreme pain and/or go into shock so, for your first infusion do ask your nurse to slow the normal drip rate to ensure that you are not allergic. If you tolerate the infusion without allergic reaction, the infusion rate can be increased.
It is very common and recommended that you be pre-dosed with an antihistamine to control allergic responses to the drug. In addition, rapid infusion of additional antihistamines generally counteracts any severe allergic reaction. One member of the Advanced Prostate Cancer On-line Support Group reported that he had an extremely painful allergic response within one minute of the start of the infusion. Benadryl was quickly administered to combat the allergic reaction. Others report that they always receive Benadryl prior to the Taxotere infusion.
Each infusion takes a few hours to be completed.
It is common to have an IV port inserted, which makes administering the chemo easier on you. The installation of the port is often performed as an outpatient procedure, although it is still significant surgery. The actual surgery can cost as much as US $10,000 so make sure that your insurance company has agreed to pay for it before you have it done.
Prior to having the port put in, take off your shirt, sit in your car, and use a magic marker or something similar to draw a line across your chest where your seatbelt normally crosses your chest to make sure that when the port is installed it won’t interfere with your seatbelt. If the seatbelt does irritate the port area, such that you need to wear the shoulder part of the seatbelt tucked under your arm, carry a doctor’s letter or prescription to avoid an “improper use of seatbelt” ticket.
Since the port is a direct access into your veins it is important to always keep it clean. If you see any sign of an infection of any sort, call your doctor and go to the emergency room. This can be a life-threatening event.
There are on-going clinical trials investigating whether administering Taxotere earlier in the course of the disease will provide additional efficacy. In a trial called E3805 that enrolled 790 men with metastatic prostate cancer between July 2006 and November 2012, the men in the trial received either initial ADT alone or ADT with docetaxel every 3 weeks for 18 weeks.
Early results showed a significant improvement in the overall survival for men who received ADT plus docetaxel compared to ADT alone (3-year survival rates of 69.0% vs. 52.5%, respectively).
However, there is an important caveat, as the majority of benefit was limited to men receiving both ADT and chemotherapy who had significant metastasis (3-year survival rates of 63.4% vs. 43.9%, respectively). As a result, the investigators noted that the use of chemotherapy in combination with ADT should be limited to only men with high-extent (multiple metastases) metastatic prostate cancer. (http://advancedprostatecancer.net/?p=4246)
CAUTION: Men taking Taxotere who are not castrate resistant should be aware that they are actually on an experimental protocol.
A recent FDA warning (http://www.fda.gov/Drugs/DrugSafety/ucm401752.htm) has indicated that some formulations of Taxotere have large quantities of ethanol and could cause an individual to become intoxicated. If you are unable to consume alcohol because of a co-morbidity issue make sure that your doctor orders either the two-vial formulation of the drug manufactured by Sanofi, with 2 grams per 200 mg dose or Docefrez, manufactured by Sun Pharma, at 2.9 grams per dose.
Combination chemotherapy regimens appear to be superior to single agent regimens. There are a number of drugs and supplements that tend to amplify the positive effects of docetaxel (Taxotere). The most commonly used synergistic treatment is carboplatin. However, Sillibinin, Celebrex and Zometa have all been used in combination with docetaxel. (For more information, do a Pub Med search for additional information, if desired.) Preclinical studies showed that treatment with COX-2 inhibitors also augmented the anti-tumor effects of docetaxel. (Citation: Altorki NK, J of Clinical Oncology 21:2645, 2003)
As with all cancer therapies, some men will derive benefit while others will not. Most men have a positive response to Taxotere, including a lowering of PSA, pain relief, and reduction in tumors as evidenced on scans and by pain relief. The duration of response varies. Some men only experience the benefits for a few months, while others have a longer benefit period. Also, many men will require supportive care while taking Taxotere, including the possibility of hospitalization.
The National Cancer Institute (NCI) has a number of web sites about chemotherapy that might be worth exploration. These include:
Chemotherapy and You: Support for People with Cancer at: http://www.cancer.gov/cancertopics/coping/chemotherapy-and-you
Eating Hints Before, During, and After Cancer Treatment at: http://www.cancer.gov/cancertopics/coping/eatinghints
Chemotherapy Side Effects Fact Sheets: http://www.cancer.gov/cancertopics/coping/chemo-side-effects
Chemotherapy Side Effects
Commonly reported side effects include:
- Hair loss (alopecia)
- Loss of appetite
- Loss or change of taste
- Eye tearing
- Bone marrow suppression (leading to anemia)
- Fluid retention (edema)
- Peripheral neuropathy (tingling feelings in the hands and feet)
- Skin rash
- Fever without an infection
- Low white blood count leading to an increased risk of infection
- Nail changes including color changes and brittleness
- Breathing difficulty
Eye tearing can lead to scarring; so let your oncologist know if you experience this side effect. Ask for a referral to an ophthalmologist who has experience with oncology patients.
One of the major problems experienced by men on taxotere (chemotherapy) is anemia, which is characterized as a low red blood cell count. Anemia is often the cause of significant fatigue, another major complaint from men on chemotherapy. Aranesp and Procrit are both synthetic versions of the naturally occurring hormone erythropoietin that stimulates red blood cell production. Aranesp or Procrit is normally administered every two to three weeks while on chemotherapy. Usually, they will safely maintain an adequate red-blood-cell level.
Edema can become painful and dangerous — see the section below about edema. Edema is an underreported problem. Ask your doctor about any swelling you may experience.
There is a good post about Taxotere chemotherapy, its administration and side effects at: http://www.advancedprostatecancer.net/?p=306