Adverse reactions docetaxel

Docetaxel should be administered the day after trastuzumab for the first cycle because of the potential for infusion-related reactions to trastuzumab, particularly during or after the first administration. Serious adverse reactions to trastuzumab infusion that have been reported infrequently include dyspnoea (shortness of breath), hypotension, wheezing, hypertension, bronchospasm, supraventricular tachyarrhythmia, reduced oxygen saturation, anaphylaxis, respiratory distress and urticaria (itching). The majority of these events occur during or within 2.5 hours of the start of the first infusion. Should an infusion reaction occur, the infusion should be discontinued and the patient monitored until resolution of any observed symptoms - the infusion may be resumed when symptoms abate. If the first cycle is well tolerated then dosing of the drugs in future cycles may occur on the same day. 

Metabolism/elimination Hepatic metabolism Adverse reactions Alopeda, nausea/vomiting/diarrhea, myelosuppression (dose-limiting, granulocytopenia, and thrombocytopenia), hepatic toxidty, peripheral neuropathy, hypersensitivity reactions, myalgias/arthralgias, rare cardiovascular events, fluid retention/pulmonary edema (docetaxel). 

Taxanes such as docetaxel and paclitaxel are mitotic inhibitors, disrupting microtubule function so adverse reactions, including hypersensitivity responses, to these drugs might be expected. 

Weekly docetaxel regimens have also been investigated, but there are mixed reports regarding tolerability some studies have reported a fairly similar adverse reactions profile to 3-weekly docetaxel [112 ], while others have reported significantly less myelo-suppression with the weekly regimens [113 ]. 

Lactation Docetaxel is lipophilic, but it is not known whether it is secreted into breast milk. However, because of the potential for adverse reactions in nursing infants, breastfeeding must be stopped while the mother is receiving docetaxel [111 ]. 

Sensory systems Eyes Blockage of the lacrimal ducts, resulting in epiphora (overflow of tears on to the face due to disturbed outflow) is a little known but common adverse reaction to weekly docetaxel, and required corrective surgery in 30 out of 71 patients in one study [129 ]. The incidence of epiphora was much less in patients treated with 3-weekly docetaxel only three of 72 patients required surgery in the same study. 

Hematologic Neutropenia was the dose-limiting adverse reaction in most phase I and phase II studies of docetaxel, with a median duration to nadir counts of 7 days [132 ]. This appears to be dose-related, but not schedule-related (unlike paclitaxel). In a large phase III trial, 9.6% of patients receiving 3-weekly docetaxel 75 mg/m developed grade 3/4 neutropenia [112 ]. 

Adverse effects of paclitaxel and docetaxel are similar, being hypersensitivity reactions, bone marrow suppression, peripheral neuropathy, hair loss and cardiac arrhythmias. 

---