Besides the blood problems and the gastric problems I discussed in the last two posts, taxotere can also cause hair loss and have effects on your skin and nails. The q3wk dose of taxotere (higher dose once every 3 weeks) is associated with reversible hair loss in two-thirds of men going on that schedule and the q1wk schedule (lower dose every week) is associated with milder hair loss about in about 50% of men on this schedule. However, the q1wk regimen usually results in more fingernail changes, which may include pain, brittleness, and fluid discharge. Just like my suggestion in post II to suck on ice cubes during the infusion, cooling the fingernails with ice during infusion greatly reduces the risk of this complication.

Irritation of the tear ducts tends to occur more often with the q1wk regimen. This occurs when the tear ducts become scarred and are unable to drain tears adequately. Symptoms of this problem can include redness, chronic watery discharge, and dry eyes. To prevent this problem, many men use artificial tears to flush Taxotere from the eyes during and after each infusion.

Neutopathy is another side effect that can develop over time. Neuropathy is numbness and sometimes tingling in the toes and fingers. Generally, these symptoms are mild and slowly reverse after Taxotere is stopped. High doses of glutamine, an amino acid supplement, can minimize the severity of neuropathy.

Fluid retention can occur with Taxotere, especially with the q3wk regimen. The first signs of this complication are swelling of the feet and ankles along with weight gain. If this fluid retention is in the chest or around the heart, it can be life threatening. Dexamethasone tablets may protect men on taxotere from significant fluid retention. Early use of diuretics can also prevent this problem and resolve it once the problem develops.

A review of my last two posts and today’s post does acknowledge that for some men taxotere is difficult, however, overall, Taxotere® is well tolerated and has been proven to extend life. Prostate Oncology Specialists published a pilot trial5 in 2001 evaluating the tolerability of Taxotere in elderly men. The average age of the group was 78 years old. The oldest man was 87. Using the weekly protocol, we found that Taxotere could be tolerated by almost anyone. In that study, 17 out of 20 men completed a full course of therapy. The three men who decided to stop the treatment early did so because of excessive fatigue.

The successful administration of taxotere requires diligent surveillance so that potential complications can be detected and corrected before they become severe.

Joel T Nowak, M.A., M.S.W.