| Cycle length: 21 days. |
| Drug | Dose and route | Administration | Given on days |
| Docetaxel | 75 mg/m2 IV* | Dilute in 250 mL normal saline and administer over one hour. | Day 1 |
| Prednisone | 5 mg orally | Twice daily. | Days 1 to 21 |
| Pretreatment considerations: |
| Emesis risk | - LOW (10 to 30% frequency of emesis).
- Refer to UpToDate topic on "Prevention and treatment of chemotherapy-induced nausea and vomiting in adults".
|
| Prophylaxis for infusion reaction and fluid retention | - Premedicate with dexamethasone prior to docetaxel administration.[2]
- Refer to UpToDate topic on "Infusion reactions to systemic chemotherapy".
|
| Vesicant/irritant properties | - Docetaxel is an irritant but can cause significant tissue damage; avoid extravasation.
- Refer to UpToDate topic on "Extravasation injury from chemotherapy and other non-antineoplastic vesicants".
|
| Infection prophylaxis | - Primary prophylaxis with hematopoietic growth factors is not recommended (incidence of febrile neutropenia approximately 3%[1]).
- Refer to UpToDate topic on "Use of granulocyte colony stimulating factors in adult patients with chemotherapy-induced neutropenia and conditions other than acute leukemia, myelodysplastic syndrome, and hematopoietic cell transplantation".
|
| Dose adjustment for baseline liver or renal dysfunction | - Docetaxel should not be administered to patients with a serum bilirubin above the ULN or to patients with transaminase elevations >1.5 times the ULN in conjunction with alkaline phosphatase >2.5 times the ULN.[2]
- Refer to UpToDate topic on "Chemotherapy hepatotoxicity and dose modification in patients with liver disease: Conventional cytotoxic agents" and "Chemotherapy hepatotoxicity and dose modification in patients with liver disease: Molecularly targeted agents".
|
| Dose adjustment for known drug interactions | - Caution is required if administering docetaxel with strong CYP3A4 inhibitors.¶ According to the United States Prescribing Information, avoid the use of docetaxel with strong CYP3A4 inhibitors (if possible). If concomitant therapy cannot be avoided, monitor closely for toxicity and consider a docetaxel dose reduction.[2] Docetaxel dose reductions for concomitant therapies should be individualized based on patient factors (eg, performance status) and the intent of therapy (ie, curative or palliative).
- Refer to "Suggested dose modifications for toxicity" below.
|
| Monitoring parameters: |
- CBC with differential at least every three weeks during treatment.
|
- Renal and liver function testing at least every three weeks during treatment.
|
- Monitor for neurologic function and gastrointestinal toxicities.
|
- Patients with renal impairment, hyperuricemia, and bulky tumors are at risk for TLS and should undergo correction of dehydration and lowering of high serum uric acid levels prior to treatment initiation, and be closely monitored for TLS during and after treatment.
- Refer to UpToDate topics on "Tumor lysis syndrome: Definition, pathogenesis, clinical manifestations, etiology and risk factors" and "Tumor lysis syndrome: Prevention and treatment".
|
| Suggested dose modifications for toxicity: |
| Myelotoxicity | - Docetaxel should only be administered if the absolute neutrophil count is >1500 cells/microL. Reduce docetaxel to 60 mg/m2 for subsequent cycles for severe prolonged neutropenia (<500 cells/microL lasting seven days or more), febrile neutropenia, or an infection with life-threatening consequences.[2]
|
| Cutaneous, mucosal, and neurologic toxicity | - For severe or cumulative cutaneous reactions (erythema, desquamation), grade 3 or 4 stomatitis or >grade 2 neurosensory signs and/or symptoms, reduce docetaxel dose to 60 mg/m2.[1] Discontinue docetaxel if toxicity persists at the lower dose.
|
| Hepatotoxicity | - Docetaxel dose reduction may be needed for patients who develop significant alterations in transaminases and alkaline phosphatase during therapy. Docetaxel should not be administered to patients with a serum bilirubin above the ULN or to patients with transaminase elevations >1.5 times the ULN in conjunction with alkaline phosphatase >2.5 times the ULN.
- Refer to UpToDate topic on "Chemotherapy hepatotoxicity and dose modification in patients with liver disease: Conventional cytotoxic agents" and "Chemotherapy hepatotoxicity and dose modification in patients with liver disease: Molecularly targeted agents".
|
| If there is a change in body weight of at least 10%, doses should be recalculated. |
