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Docetaxel

 

Key Terms: 10-deacetyl baccatin III, Hypersensitivity, Microtubles, Taxoids.

Definition

Docetaxel is a drug used to treat certain types of cancer. Docetaxel is available under the trade name Taxotere.

Purpose

Docetaxel is an antineoplastic agent used to treat breast cancer and non-small cell lung carcinoma.

Description

Docetaxel was approved by the Food and Drug Administration (FDA) in 1996.

Docetaxel is a synthetic derivative of the naturally occurring compound paclitaxel. Docetaxel is synthesized from the naturally occurring compound, 10-deace-tyl baccatin III, which is extracted from the needles of yew plants. Docetaxel belongs to a group of chemicals called taxoids. The chemical structure and biological action of docetaxel is similar to that of paclitaxel.

Docetaxel promotes the formation of microtubules that do not function properly. One of the roles of normal microtubules is to aid in cell duplication. By disrupting this function, docetaxel inhibits cell reproduction.

Docetaxel is used in patients who have breast cancer that has recurred or progressed following treatment with other drugs. It is also used to treat non-small cell lung carcinoma alone, or in combination with platinum-containing drugs such as cisplatin. Some increases in survival times have been observed in patients treated with regiments that include docetaxel compared to control populations.

Recommended Dosage

There is no known antidote for docetaxel overdose, so patients should be carefully monitored during treatment for toxicity.

Docetaxel is administered intravenously, in a dose that ranges from 60–100 mg/m2, over one hour, once every three weeks. The initial dose may be adjusted downward depending on patient tolerance to the toxic side effects of the drug. Also, blood tests may be necessary to ensure that the bone marrow is functioning adequately to continue treatment at the recommended interval.

All patients should be pretreated with corticosteroids such as dexamethasone prior to docetaxel administration, to help prevent adverse side effects. These side effects include severe hypersensitivity to docetaxel treatment and fluid retention. Premedication should start one day prior to docetaxel treatment and continue for three to five days.

Precautions

Docetaxel should only be used under the supervision of a physician experienced in the use of cancer chemotherapeutic agents. Special caution should be taken to monitor the toxic effects of docetaxel, especially suppression of bone marrow function and hypersensitivity reactions. Premedication to prevent hypersensitivity reactions is recommended. Minor to severe hypersensitivity reactions may occur within a few minutes of the start of treatment. Severe hypersensitivity requires treatment. Certain complications will only be possible to manage if the necessary diagnostic and treatment resources are readily available.

Because docetaxel is administered intravenously, the site of infusion should be monitored for signs of inflammation.

Adverse effects of docetaxel treatment in patients with significant liver dysfunction are more likely. High doses of treatment also may increase the likelihood and severity of adverse side effects.

Docetaxel should not be administered to patients who are known to have severe hypersensitivity to polysorbate 80, which is a component of the treatment that helps dissolve the drug.

The safety of docetaxel in children under 16 years of age has not been established.

Docetaxel can cause harm to a fetus when administered to pregnant women. This treatment should be used during pregnancy only in life-threatening situations. Women of child bearing age are advised not to become pregnant during treatment. Women should stop nursing before beginning treatment, due to the potential for serious adverse side effects in nursing infants.

Side Effects

Suppression of bone marrow function is the principal adverse side effect associated with docetaxel treatment. Blood tests will allow a doctor to determine if there is adequate bone marrow function to begin or continue treatment. Hypersensitivity and fluid retention may also occur during treatment. Corticosteroids are administered prior to treatment to lessen these side effects. Ulceration of the mouth and surrounding areas is possible. Additional side effects, including fever, decrease in blood pressure, nausea and vomiting, diarrhea, pain, abnormal liver function, skin rash, nerve damage, and hair loss (alopecia) may occur.

A 2003 study showed that although docetaxel produced higher toxicities among patients in the short-term, breast cancer patients treated with docetaxel had higher survival and similar quality of life scores than those treated with paclitaxel. Although the women experienced more side effects such as reduction in white blood cells, some loss of strength, infection, and mouth ulcers, among others, the effects did not affect their quality of life over time. And the women survived longer.

Interactions

As of 2003, no formal studies had been reported exploring interactions between docetaxel and other medications. Drugs that may alter the metabolism of docetaxel such as cyclosporine, terfenadine, ketoconazole, erythomycin and troleandomycin should be used with caution due to the potential for interactions.

Resources

Periodicals

"Comparison Study Finds Better Overall Response Rate, Survival with Docetaxel." Drug Week October 17, 2003: 67.

"Study Shows Improved Survival Rates, Time to Disease Progression with Docetaxel." Women's Health Weekly December 25, 2003: 33.

—Marc Scanio; Teresa G. Odle

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Drug Info: Docetaxel
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Brand names: Taxotere®

Chemical formula:



Docetaxel Solution for injection

What is this medicine?

DOCETAXEL (doe se TAX el) is a chemotherapy drug. It targets fast dividing cells, like cancer cells, and causes these cells to die. This medicine is used to treat many types of cancers like breast cancer, certain stomach cancers, head and neck cancer, lung cancer, and prostate cancer.
 
This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:
•infection (especially a virus infection such as chickenpox, cold sores, or herpes)
•liver disease
•low blood counts, like low white cell, platelet, or red cell counts
•an unusual or allergic reaction to docetaxel, polysorbate 80, other chemotherapy agents, other medicines, foods, dyes, or preservatives
•pregnant or trying to get pregnant
•breast-feeding

How should I use this medicine?

This drug is given as an infusion into a vein. It is administered in a hospital or clinic by a specially trained health care professional.

A patient information sheet for the product will be given with each prescription and refill. Read this sheet carefully each time. The sheet may change frequently.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.

What may interact with this medicine?

•cyclosporine
•erythromycin
•ketoconazole
•medicines to increase blood counts like filgrastim, pegfilgrastim, sargramostim
•vaccines

Talk to your doctor or health care professional before taking any of these medicines:
•acetaminophen
•aspirin
•ibuprofen
•ketoprofen
•naproxen

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Your condition will be monitored carefully while you are receiving this medicine. You will need important blood work done while you are taking this medicine.

This drug may make you feel generally unwell. This is not uncommon, as chemotherapy can affect healthy cells as well as cancer cells. Report any side effects. Continue your course of treatment even though you feel ill unless your doctor tells you to stop.

In some cases, you may be given additional medicines to help with side effects. Follow all directions for their use.

Call your doctor or health care professional for advice if you get a fever, chills or sore throat, or other symptoms of a cold or flu. Do not treat yourself. This drug decreases your body's ability to fight infections. Try to avoid being around people who are sick.

This medicine may increase your risk to bruise or bleed. Call your doctor or health care professional if you notice any unusual bleeding.

Be careful brushing and flossing your teeth or using a toothpick because you may get an infection or bleed more easily. If you have any dental work done, tell your dentist you are receiving this medicine.

Avoid taking products that contain aspirin, acetaminophen, ibuprofen, naproxen, or ketoprofen unless instructed by your doctor. These medicines may hide a fever.

Do not become pregnant while taking this medicine. Women should inform their doctor if they wish to become pregnant or think they might be pregnant. There is a potential for serious side effects to an unborn child. Talk to your health care professional or pharmacist for more information. Do not breast-feed an infant while taking this medicine.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:
•allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
•low blood counts - This drug may decrease the number of white blood cells, red blood cells and platelets. You may be at increased risk for infections and bleeding.
•signs of infection - fever or chills, cough, sore throat, pain or difficulty passing urine
•signs of decreased platelets or bleeding - bruising, pinpoint red spots on the skin, black, tarry stools, nosebleeds
•signs of decreased red blood cells - unusually weak or tired, fainting spells, lightheadedness
•breathing problems
•fast or irregular heartbeat
•low blood pressure
•mouth sores
•nausea and vomiting
•pain, swelling, redness or irritation at the injection site
•pain, tingling, numbness in the hands or feet
•swelling of the ankle, feet, hands
•weight gain

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
•bone pain
•complete hair loss including hair on your head, underarms, pubic hair, eyebrows, and eyelashes
•diarrhea
•excessive tearing
•changes in the color of fingernails
•loosening of the fingernails
•nausea
•muscle pain
•red flush to skin
•sweating
•weak or tired

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

This drug is given in a hospital or clinic and will not be stored at home.

Last updated: 7/1/2002

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

Wikipedia: Docetaxel
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Docetaxel
Systematic (IUPAC) name
(2R,3S)-N-carboxy-3-phenylisoserine, N-tert-butyl ester, 13-ester with 5, 20-epoxy-1, 2, 4, 7, 10, 13-hexahydroxytax-11-en-9-one 4-acetate 2-benzoate, trihydrate
Identifiers
CAS number 114977-28-5
ATC code L01CD02
PubChem 148124
DrugBank APRD00932
ChemSpider 58313
Chemical data
Formula C43H53NO14 
Mol. mass 807.879 g/mol
Pharmacokinetic data
Bioavailability NA
Protein binding >98%
Metabolism Hepatic
Half life 86 hours
Excretion Biliary
Therapeutic considerations
Pregnancy cat.

?

Legal status
Routes IV


Docetaxel (trade name Taxotere) is a clinically well established anti-mitotic chemotherapy medication used mainly for the treatment of breast, ovarian, and non-small cell lung cancer.[1][2] Docetaxel has an approved claim for treatment of patients who have locally advanced, or metastatic breast or non small-cell lung cancer who have undergone anthracycline-based chemotherapy and failed to stop cancer progression or relapsed.[3] Administered as a one-hour infusion every three weeks generally over a ten cycle course, docetaxel is considered as or more effective than doxorubicin, paclitaxel and fluorouracil as a cytotoxic antimicrotubule agent.[1] Docetaxel is marketed worldwide under the name Taxotere by Sanofi-Aventis.[4] Annual sales approx $2bn. Patent expires in 2010.

Contents

Chemical structure, nature, and composition

Nature

Docetaxel is of the chemotherapy drug class; taxane, and is a semi-synthetic analogue of paclitaxel (Taxol), an extract from the rare Pacific yew tree Taxus brevifolia.[2] Due to scarcity of paclitaxel, extensive research was carried out leading to the formulation of docetaxel – an esterified product of 10-deacetyl baccatin III, which is extracted from the renewable and readily available European yew tree.

Docetaxel differs from paclitaxel at two positions in its chemical structure. It has a hydroxyl functional group on carbon 10, whereas paclitaxel has an acetate ester, and a tert-butyl carbamate ester exists on the phenylpropionate side chain instead of the benzyl amide in paclitaxel. The carbon 10 functional group change causes docetaxel to be more water soluble than paclitaxel.[2]

Formulations and compositions

Docetaxel is a white powder and is the active ingredient available in 20 mg and 80 mg Taxotere single-dose vials of concentrated anhydrous docetaxel in polysorbate 80.[5][2] The solution is a clear brown-yellow containing 40 mg docetaxel and 1040 mg polysorbate 80 per mL.[5] 20 mg Taxotere is distributed in a blister carton containing one single-dose vial of Taxotere (docetaxel) preparation in 0.5 mL sterile pyrogen-free anhydrous polysorbate 80, and a single dose Taxotere solvent vial containing 1.5 mL 13% ethanol in saline to be combined and diluted in a 250 mL infusion bag containing 0.9% sodium chloride or 5% glucose for administration.[5] 80 mg Taxotere is supplied identically but with 2.0 mL polysorbate 80 and 6.0 mL 13% ethanol in saline. The docetaxel and solvent vials are combined to give a solution of 10 mg/mL and the required dose is drawn from this solution. Vials have an overfill to compensate for liquid loss during preparation, foaming, adhesion to vial walls and the dead volume. 20 mg vials may be stored for 24 months below 25°C away from light and 80 mg vials for 26 months in the same conditions.[5]

Active regions

A model based on electron crystallographic density and nuclear magnetic resonance deconvolution has been proposed to explain the binding of docetaxel to β-tubulin.[6] In this T-shaped/butterfly model, a deep hydrophobic cleft exists near the surface of the β-tubulin where three potential hydrogen bonds and multiple hydrophobic contacts bind to docetaxel. The hydrophobic pocket walls contain helices H1, H6, H7 and a loop between H6 and H7 that form hydrophobic interactions with the 3’-benzamido phenyl, 3’-phenyl, and the 2-benzoyl phenyl of docetaxel. 3’-phenyl also has contact with β-sheets B8 and B10. The C-8 methyl of docetaxel has Van der Waals interactions with two residues, Thr-276 and Gln-281 near the C-terminal end of β-tubulin. Docetaxel’s O-21 experiences electrostatic attraction to Thr-276 and the C-12 methyl has proximity with Leu-371 on the loop between B9 and B10.[6]

Pharmacokinetics

Absorption and distribution

Intravenous administration of docetaxel results in 100% bioavailability and absorption is immediate.[7] Oral bioavailability has been found to be 8% ±6% on its own and, when co-administered with cyclosporine, bioavailability increased to 90% ± 44%.[8] In practice, docetaxel is administered intravenously only to increase dose precision.[2][5][9][10] Evaluation of docetaxel pharmacokinetics in phase II and III clinical studies were with 100 mg/m² dosages given over one-hour infusions every three weeks.[2].

Docetaxel was shown to be greater than 98% plasma protein bound independent of concentration at 37°C and pH 7.4[11] Docetaxel's plasma protein binding includes lipoproteins, alpha1 acid glycoprotein and albumin. Alpha1 acid glycoprotein is the most variable of these proteins inter-individually, especially in cancer patients and is therefore the main determinant of docetaxel's plasma binding variability.[11] Docetaxel interacted little with erythrocytes and was unaffected by the polysorbate 80 in its storage medium.[2][11]

The concentration-time profile of docetaxel was consistent with a three-compartment pharmacokinetic model.[2][5] An initial, relatively rapid decline, with an α half-life of mean 4.5 minutes is representative of distribution to peripheral compartments from the systemic circulation. A β half-life of mean 38.3 minutes and a relatively slow γ half-life of mean 12.2 hours represent the slow efflux of docetaxel from the peripheral compartment.[2][5]

Administration a 100 mg/m² dose over a one hour infusion gave a mean total body clearance of 21 L/h/m² and a mean steady state volume of distribution of 73.8 L/m² or 123 L based on the mean BSA (body surface area) of 1.68 m².[2][5] Area under the plasma concentration-time curve had a mean value of 2.8 mg.h/L.[2] The Cmax of docetaxel was found to be 4.15 ± 1.35 mg/L.[12] Increased dose resulted in a linear increase of the area under the concentration-time curve and so it is concluded that dose is directly proportional to plasma concentration.[2]

Metabolism and excretion

Docetaxel is mainly metabolised in the liver by the cytochrome P450 CYP3A4 and CYP3A5 subfamilies of isoenzymes.[2][13][14] Metabolism is principally oxidative and at the tert-butylpropionate side chain, resulting first in an alcohol docetaxel (M2), which is then cyclised to three further metabolites (M1, M3 and M4).[14] M1 and M3 are two diasteromeric hydroxyoxazolidinones and M4 is an oxazolidinedione. Phase II trials of 577 patients showed docetaxel clearance to be related to body surface area and; hepatic enzyme and alpha1 acid glycoprotein, plasma levels.[11] The following model is agreed to represent docetaxel clearance in humans:

CL = BSA · (22.1 − 3.55·AAG − 0.095·AGE + 0.2245·ALB) · (1 − 0.334·HEP12)

where CL is total body clearance (L/h), BSA is total body surface area (m²), AAG and ALB represent alpha1 acid glycoprotein and albumin plasma concentrations (g/L) respectively, and AGE is the patients age (years).[2] HEP12 represents a measure of hepatic dysfunction, affecting clearance of docetaxel. This final model accounted for a modest proportion of patients and identified most of the patients varying from the model (population median of CL = 35.6 L/h) as having hepatic dysfunction, indicating hepatic function as the most unpredictable factor with regards to clearance variability.[2]

Patients with significant hepatic dysfunction had an approximately 30% decrease in clearance of docetaxel and were also at a higher risk of toxicity poisoning from docetaxel treatment.[2] Clearance has been shown from population pharmacokinetic studies to decrease significantly with age, increased alpha1 acid glycoprotein and albumin concentrations and decreased body surface area.[2]

Renal impairment is unlikely to affect metabolism or excretion of docetaxel as renal excretion contributes less than 5% of elimination.[2] Limited data is available for docetaxel use in children with dosage between 55 and 75 mg/m². Two paediatric studies have taken place that show a mean clearance of 33 L/h/m² and concentration-time profiles best fitted by a two-compartmental model of distribution and elimination. Mean distribution half-life was 0.09 hours and mean elimination half-life was 1.4 hours in paediatric studies.[2]

Biodistribution of 14C-labelled docetaxel in three patients showed the bulk of the drug to be metabolised and excreted in bile to the faeces.[2] Of the radioactively labelled docetaxel administered, 80% was eliminated to the faeces with 5% in the urine over seven days, an indication that urinary excretion of docetaxel is minimal. Saliva contributed minimal excretion and no excretion was detected through pulmonary means.[2] The terminal half-life of docetaxel was determined as approximately 86 hours, through prolonged plasma sampling, contrary to the clinically stated terminal half-life of 10-18 hours.[8][12]

Mechanism of action

Molecular target

Docetaxel binds to microtubules reversibly with high affinity and has a maximum stoichiometry of 1 mole docetaxel per mole tubulin in microtubules.[15] This binding stabilises microtubules and prevents depolymerisation from calcium ions, decreased temperature and dilution, preferentially at the plus end of the microtubule.[15] Docetaxel has been found to accumulate to higher concentration in ovarian adenocarcinoma cells than kidney carcinoma cells, which may contribute to the more effective treatment of ovarian cancer by docetaxel.[1][15] It has also been found to lead to the phosphorylation of oncoprotein bcl-2, which is apoptosis blocking in its oncoprotein form.[1]

Modes of action

The cytotoxic activity of docetaxel is exerted by promoting and stabilising microtubule assembly, while preventing physiological microtubule depolymerisation/disassembly in the absence of GTP.[1][16][17] This leads to a significant decrease in free tubulin, needed for microtubule formation and results in inhibition of mitotic cell division between metaphase and anaphase, preventing further cancer cell progeny.[1][5][15]

Because microtubules do not disassemble in the presence of docetaxel, they accumulate inside the cell and cause initiation of apoptosis.[15] Apoptosis is also encouraged by the blocking of apoptosis-blocking bcl-2 oncoprotein.[1] Both in vitro and in vivo analysis show the anti-neoplastic activity of docetaxel to be effective against a wide range of known cancer cells, cooperate with other anti-neoplastic agents activity, and have greater cytotoxicity than paclitaxel, possibly due to its more rapid intracellular uptake.[1]

The main mode of therapeutic action of docetaxel is the suppression of microtubule dynamic assembly and disassembly, rather than microtubule bundling leading to apoptosis, or the blocking of bcl-2.[1][15]

Cellular responses

Docetaxel exhibits cytotoxic activity on breast, colorectal, lung, ovarian, gastric, renal and prostate cancer cells.[1] Docetaxel does not block disassembly of interphase microtubules and so does not prevent entry into the mitotic cycle, but does block mitosis by inhibiting mitotic spindle assembly.[15] Resistance to paclitaxel or anthracycline doxorubicin does not necessarily indicate resistance to docetaxel.[1] Microtubules formed in the presence of docetaxel are of a larger size than those formed in the presence of paclitaxel, which may result in improved cytotoxic efficacy.[17] Abundant formation of microtubules and the prevention to replicate caused by the presence of docetaxel leads to apoptosis of tumour cells and is the basis of docetaxel use as a cancer treatment.[17] It is unknown if pathophysiological interactions with docetaxel exist at this stage, however tumour type has been shown to have efficacy on cellular activity.[1] Docetaxel activity is significantly greater in ovarian and breast tumours than for lung tumours.[1]

Therapeutic Applications and Effects

A woman being treated with docetaxel chemotherapy for breast cancer. Cold mittens and wine coolers are placed on her hands and feet to prevent deleterious effects on the nails. Similar strategies can be used to prevent hair loss.

Therapeutic applications

The main use of docetaxel is the treatment of a variety of cancers after the failure of anthracycline-based chemotherapy.[3] Marketing of docetaxel as Taxotere is mainly towards the treatment of breast, prostate and other non-small cell cancers.[4] Clinical data has shown docetaxel to have cytotoxic activity against breast, colorectal, lung, ovarian, prostate, liver, renal, gastric, head and neck cancers, and melanoma.[1][5]

In the treatment of breast cancer, eight phase II studies were carried out in patients with either locally advanced or metastatic breast cancer.[5] A total of 283 previously untreated and treated patients underwent the following dose allocations;

Numbers of patients in each dose regiment and previous treatment state
Dosage 75 mg/m² 100 mg/m² Total
Previously Untreated 55 117 172
Previously Treated - 111 111
283

Taxotere was administered over a one-hour infusion every three weeks for these trials.[5] The 75 mg/m² cohort showed an overall response rate of 47% and 9% complete responses. Duration of response and the time to progression (treatment failure) had median values of 34 weeks and 22 weeks, respectively. Patients with two or fewer organs involved had a response rate of 58.6%, whereas patients with three or more organs involved showed 29.4% response.[5]

Previously untreated patients in the 100 mg/m² cohort had an overall response rate of 56% and 9.4% complete responses.[5] The previously treated population had an overall response of 48.6% and 3.6% complete responses. Median duration of response and time to progression was 30 weeks and 21 weeks for the previously untreated population and 28 weeks and 19 weeks for the previously treated patients. The 100 mg/m² cohort showed higher toxicity. Previously untreated patients with three or more organs involved had a 54.3% response rate and previously treated patients had a 55.8% response rate.[5]

Two randomised phase III studies of 326 alkylating agent failure and 392 anthracycline failure metastatic breast cancer patients have been carried out with 100 mg/m² dosages administered over a one-hour infusion every three weeks for seven and ten cycles respectively.[5] While no significant differences in median time to progression or survival were observed between docetaxel and doxorubicin in alkylating agent failure patients, anthracycline failure patients showed increased response rate to docetaxel. Median time to progression and median overall survival were also improved with docetaxel.[5]

The following table is the results of an unpublished, non-peer reviewed, comparative, open-label, randomised phase III study of docetaxel and paclitaxel assigned randomly to 449 patients with advanced breast cancer.[5] Docetaxel was administered as a one-hour infusion of 100 mg/m² Taxotere every three weeks and paclitaxel as a three-hour infusion of 175 mg/m² paclitaxel every three weeks.

Results of an open-label, multicentre, randomised phase III study in 449 advanced breast cancer patients, comparing efficacy of docetaxel and paclitaxel
Endpoint Docetaxel 100 mg/m² n=225 Paclitaxel 175 mg/m² n=224 p-value
Median survival (months) 15.3 12.7 0.03
Median time to progression (weeks) 24.6 15.6 <0.01
Overall response rate (%) 32.0 25.0 0.10
Overall response rate in evaluable population (%) 37.0 26.0 0.01

Clinical studies have taken place for the treatment of non-small cell lung cancer and prostate cancer.[5] Patients treated for non-small cell lung cancer in phase II studies with 100 mg/m² docetaxel showed an overall response rate of 26.9% for previously untreated patients (n=160) and 17% for previously treated patients (n=88). Median survival time for previously untreated patients was nine months and for previously treated patients, eight months.[5]

The TAX 327 trial was a phase III study that showed significant survival benefit from docetaxel in androgen-independent metastatic prostate cancer.[18] Compared with mitoxantrone treatment, docetaxel treated patients showed a 12% overall response rate and mitoxantrone showed a 7% overall response rate. Another large advantage of docetaxel was increased quality of life. Docetaxel showed a 22% response and mitoxantrone had a 13% response. Used in conjunction with prednisone for pain management, docetaxel had a 35% response and Mitoxantrone had a 22% response. This trial leads docetaxel to be a preferred method of treatment to Mitoxantrone where possible.[18]

Specific outcomes and benefits of treatment

Treatment with docetaxel has the specific outcome of increasing survival time in patients with certain types of cancer.[1][2][4][5] While some clinical trials show median survival times to be increased by approximately only three months, the range of survival time is large.[5] Many patients survive beyond five years with treatment from docetaxel, however it is difficult to attribute these findings directly to treatment with docetaxel.[18] Improved median survival time and response indicates that docetaxel slows metastatic cancer progression and can lead to disease-free survival.[5][9][18] Conjunctive treatment of prednisone with docetaxel has been shown to lead to improved survival rate as well as improved quality of life and reduction of pain compared with treatments with mitoxantrone.[18] Docetaxel has been shown to improve survival as an adjuvant therapy with doxorubicin and cyclophosphamide for the treatment of node-positive breast cancer and so docetaxel has the benefit of aiding other treatments.[5]

As well as inhibiting mitosis, the presence of docetaxel has been found to lead to the phosphorylation of the oncoprotein bcl-2, which leads to apoptosis of cancer cells that had previously blocked the apoptotic inducing mechanism, leading to tumour regression.[1] Enhanced effects of radiation therapy when combined with docetaxel has been observed in mice.[1] Docetaxel has also been found to have greater cellular uptake and is retained longer intracellularly than paclitaxel allowing docetaxel treatment to be effective with a smaller dose, leading to fewer and less severe adverse effects.[17]

Monitoring and combination with other drugs

Docetaxel is administered via a one-hour infusion every three weeks over ten or more cycles.[5] Treatment is given under supervision from an oncologist and takes place in a hospital, where vital signs are monitored during infusion. Strict monitoring of blood cell counts, liver function, serum electrolytes, serum creatinine, heart function and fluid retention is required to track the progression of tumour cells, response, adverse reactions and toxicity so that treatment can be modified or terminated if necessary.[5][8]

Premedication with corticosteroids is recommended before each administration of docetaxel to reduce fluid retention and hypersensitive reactions.[5] Oral dexamethasone is given before docetaxel treatment for prostate cancer. Docetaxel is typically used for the treatment of carcinoma on its own. Other medications will often be given to aid pain management and other symptoms. The treatment of breast cancer with doxorubicin and cyclophosphamide is enhanced by adjuvant treatment with docetaxel. Docetaxel is also used in combination with capecitabine, a DNA synthesis inhibitor.[5][19]

Side-effects/contraindications/drug interactions

Adverse side effects

Docetaxel is a chemotherapeutic agent and is a cytotoxic compound and so is effectively a biologically damaging drug.[1][13] As with all chemotherapy, adverse effects are common and many varying side-effects have been documented.[5][9] Because docetaxel is a cell cycle specific agent, it is cytotoxic to all dividing cells in the body.[20] This includes tumour cells as well as hair follicles, bone marrow and other germ cells. For this reason, common chemotherapy side effects such as alopecia occur; sometimes this can be permanent. However, the drugs company Sanofi Aventis claim they do not keep this data.[20]

Incidence of commonly experienced non-haematological adverse effects reported for treatment with docetaxel. Data from 40 phase II and phase III studies (n=2045) with patients undergoing a one-hour infusion of 100 mg/m2 docetaxel once every three weeks.

Haematological adverse effects include Neutropenia (95.5%), Anaemia (90.4%), Febrile neutropenia (11.0%) and Thrombocytopenia (8.0%).[5][9] Deaths due to toxicity accounted for 1.7% of the 2045 patients and incidence was increased (9.8%) in patients with elevated baseline liver function tests (liver dysfunction).[5][9]

Observations of severe side effects in the above 40 phase II and phase III studies were also recorded.

Incidence of severe adverse effects reported in patients treated with docetaxel. Data from 40 phase II and phase III studies with patients undergoing a one-hour infusion of 100 mg/m2 docetaxel once every three weeks.

Many more side effects have been reported for conjunctive and adjuvant treatment with docetaxel as well as rare post-marketing events.[5]

Contraindications and patient factors

Docetaxel is contraindicated for use with patients with; a baseline neutrophil count less than 1500 cells/µL, a history of severe hypersensitivity reactions to docetaxel or polysorbate 80, severe liver impairment and pregnant or breast-feeding women.[5][9]

Side effects are experienced more frequently by patients of 65 years or older, but dosage is usually not decreased.[5][8] Renal failure is thought not to be a significant factor for docetaxel dosage adjustment.[8] Patients with hepatic insufficiency resulting in serum bilirubin greater than the upper limit of normal (ULN) should not be administered docetaxel, though this is not a stated contraindication. Dosage should be reduced by 20% in patients who suffer from; grade 3 or 4 diarrhoea following exposure to docetaxel, hepatotoxicity defined by liver enzymes at levels greater than five times the ULN, and grade 2 palmer-planter toxicity.[8]

Paediatric trials of docetaxel have been limited and so safety of use in patients under 16 years has not been established.[2][8]

Drug interactions

Drug interactions may be the result of altered pharmacokinetics or pharmacodynamics due to one of the drugs involved.[2] Cisplatin, dexamethasone, doxorubicin, etoposide and vinblastine are all potentially co-administered with docetaxel and did not modify docetaxel plasma binding in phase II studies.[11] Cisplatin is known to have a complex interaction with some CYPs and has in some events been shown to reduce docetaxel clearance by up to 25%.[2] Anticonvulsants induce some metabolic pathways relevant to docetaxel. CYP450 and CYP3A show increased expression in response to the use of anticonvulsants and the metabolism of docetaxel metabolite M4 is processed by these CYPs. A corresponding increase in clearance of M4 by 25% is observed in patients taking phenytoin and phenobarbital, common anticonvulsants.[2]

Common and/or likely drug-drug combinations and known side effects from drug interactions
Drug Interacting with Docetaxel Adverse Effects from Interaction
Cisplatin increased risk of delayed neuropathy
Cyclosporine, Dalfopristin, Erythromycin, Itraconazole, Ketoconazole, Quinupristin, Terfenadine, Troleandomycin increased risk of docetaxel toxicity including some or all of; anaemia, leucopoenia, thrombocytopenia, fever, diarrhoea
Doxorubicin Hydrochloride cholestatic jaundice and pseudomembranous colitis
Doxorubicin Hydrochloride Liposome increased doxorubicin exposure
Vaccinations for; Bacillus of Calmette and Guerin, Measles, Mumps, Poliovirus, Rotavirus, Rubella, Smallpox, Typhoid, Varicella, Yellow Fever increased risk of infection by live vaccine
Thalidomide increased risk of venous thromboembolism

Erythromycin, ketoconazole and cyclosporine are CYP3A4 inhibitors and therefore inhibit the metabolic pathway of docetaxel.[2] When used with anticonvulsants, which induce CYP3A4, an increased dose of docetaxel may be required.[2]

Pre-treatment with corticosteroids has been used to decrease hypersensitivity reactions and oedema in response to docetaxel and has shown no effect on the pharmacokinetics of docetaxel.[2] The efficacy of docetaxel was improved by treatment with oral capecitabine and after more than 27 months follow-up, the survival benefit has been confirmed.[1] Doxorubicin was combined with docetaxel in one study of 24 patients and resulted in an increased AUC of docetaxel by 50 to 70%, indicating doxorubicin may affect the disposition of docetaxel.[2] Etoposide has also been shown to decrease docetaxel clearance, thought patient numbers for this observation have been low.[2]

Prednisone given with docetaxel led to improved survival, quality of life and pain management in patients with hormone-refractory prostate cancer.[18]

Discovery, Regulation and Marketing

Taxotere was developed by Rhône-Poulenc Rorer (now Sanofi-Aventis) following from the discoveries of Pierre Potier at CNRS at Gif-sur-Yvette during his work on improvements to the production of Taxol.[21]

Docetaxel is currently protected by patents (U.S. patent 4814470, European patent no EP 253738, due to expire in 2010) which are owned by Sanofi-Aventis, and so is available only under the Taxotere brand name internationally.[22]

Clinical Trials

MD Anderson Cancer Center: A phase I/II study of Docetaxel, 5-Fluorouracil and Oxaliplatin (D-FOX) in patients with untreated locally unresectable or metastatic adenocarcinoma of the stomach or gastroesophageal junction.

See also

References

  1. ^ a b c d e f g h i j k l m n o p q r s Lyseng-Williamson KA, Fenton C. Docetaxel: a review of its use in metastatic breast cancer. Drugs 2005;65(17):2513-31.
  2. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae Clarke SJ, Rivory LP. Clinical pharmacokinetics of docetaxel. Clin Pharmacokinet 1999;36(2):99-114
  3. ^ a b Anonymous. Oncology Tools: Approved Claims for microtubule inhibitors. US Food and Drug Administration. at web.archive.org (17 Sep 2006). Last modified 22 Jun 1998.
  4. ^ a b c Anonymous. Taxotere.com for Healthcare Professionals: About. Sanofi-aventis U.S. LLC. http://www.taxotere.com/professional/about/index.do (17 Sep 2006). Last modified Jul 2005.
  5. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah Anonymous. Taxotere Docetaxel concentrate for infusion. Medsafe. http://www.medsafe.govt.nz/profs/Datasheet/t/taxotereinf.htm (25 Sep 2006). Last modified 6 Feb 2006.
  6. ^ a b Snyder JP, Nettles JH, Cornett B, Downing KH, Nogales E. The binding conformation of Taxol in b-tubulin: A model based on electron crystallographic density. PNAS. 2001;98(9):5312-16.
  7. ^ Rang HP, Dale MM, Ritter JM, Moore PK. Pharmacology. 5th ed. London: Churchill Livingstone; 2003. p. 100-1
  8. ^ a b c d e f g Anonymous. Drugdex Evaluations: Docetaxel. Thomson MICROMEDEX. http://www.library.auckland.ac.nz/databases/learn_database/public.asp?record=micromedex#Drugdex (26 Sep 2006). Last modified 2006.
  9. ^ a b c d e f Anonymous. Taxotere.com for Healthcare Professionals: Efficacy and Safety. Sanofi-aventis U.S. LLC. http://www.taxotere.com/professional/about/efficacy_safety.do (24 Sep 2006). Last modified Jul 2005.
  10. ^ Anonymous. New Zealand Pharmaceutical Schedule. Wellington: PHARMAC; 2006. p. 133.
  11. ^ a b c d e Urien S, Barre J, Morin C, Paccaly A, Montay G, Tillement JP. Docetaxel serum protein binding with high affinity to alpha 1-acid glycoprotein. Invest New Drugs. 1996;14(2):147-51.
  12. ^ a b Baker SD, Zhao M, Lee CKK, Verweij J, Zabelina Y, Brahmer JR, et al. Comparative pharmacokinetics of weekly and every-three-weeks docetaxel. Clin Cancer Res. 2004;10(6):1976-83.
  13. ^ a b Anonymous. Taxotere.com for Healthcare Professionals: Pharmacokinetics. Sanofi-aventis U.S. LLC. http://www.taxotere.com/professional/about/pharmacokinetics.do (23 Sep 2006). Last modified Jul 2005.
  14. ^ a b Guitton J, Cohen S, Tranchand B, Vignal B, Droz JP, Guillaumont M, et al. Quantification of docetaxel and its main metabolites in human plasma by liquid chromatography/tandem mass spectrometry. Rapid Commun Mass Spectrom. 2005;19(17):2419-26.
  15. ^ a b c d e f g Yvon AC, Wadsworth P, Jordan MA. Taxol Suppresses Dynamics of Individual Microtubules in Living Human Tumor Cells. The American Society for Cell Biology. 1999;10:947-959.
  16. ^ Anonymous. Docetaxel: Clinical Pharmacology. RxList. http://www.rxlist.com/cgi/generic3/docetaxel_cp.htm (24 Sep 2006). Last modified 29 Jun 2006.
  17. ^ a b c d Eisenhauer EA, Vermorken JB. The taxoids: Comparative clinical pharmacology and therapeutic potential. Drugs. 1998;55(1):5–30.
  18. ^ a b c d e f Tannock IF, de Wit R, Berry WR, Horti J, Pluzanska A, Chi KN, et al. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med. 2004;351(15):1502-12.
  19. ^ Goyle S, Maraveyas A. Chemotherapy for colorectal cancer. Dig Surg. 2005;22(6):401-14.
  20. ^ a b Rang HP, Dale MM, Ritter JM, Moore PK. Pharmacology. 5th ed. London: Churchill Livingstone; 2003. p. 694-8.
  21. ^ http://www.cnrs.fr/cw/en/pres/compress/mistpotier.html Pierre Potier, chemist, 1998 CNRS Gold Medalist
  22. ^ Vogel CL, Bellet RE, inventors; Aventis Pharma S.A., assignee. Use of docetaxel for treating cancers. United States patent US20016333348. 2001 Dec 25.

External links

  • Taxotere (manufacturer's prescribing information)
  • Taxotere (manufacturer's website)

 
 
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Oncology Encyclopedia. Gale Encyclopedia of Cancer. Copyright © 2006 by The Gale Group, Inc. All rights reserved.  Read more
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