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Docetaxel Use in Prostate Cancer

Docetaxel Use in Prostate Cancer . Randy A. Jones, PhD, APRN Assistant Professor University of Virginia School of Nursing Charlottesville, Virginia. What Is Docetaxel?. The only US FDA approved chemotherapeutic agent for clinical treatment of advanced hormone refractory prostate cancer

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Docetaxel Use in Prostate Cancer

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  1. Docetaxel Use in Prostate Cancer Randy A. Jones, PhD, APRN Assistant Professor University of Virginia School of Nursing Charlottesville, Virginia

  2. What Is Docetaxel? • The only US FDA approved chemotherapeutic agent for clinical treatment of advanced hormone refractory prostate cancer • A chemotherapy drug that treats cancer (eg, breast, non–small-cell non–small cell lungand prostate cancer) FDA = Food and Drug Administration. Pazdur R and Keegan P. FDA Approval for Docetaxel. Cancer Website. Available at: http://www.cancer.gov/cancertopics/druginfo/fda-docetaxel#Anchor-Prostat-16229. Accessed December 31, 2007.

  3. Investigational Phase III Trials with Docetaxel AIPC = androgen-independent prostate cancer; ASCENT = AIPC Study of Calcitriol Enhancing Taxotere; CALGB = Cancer and Leukemia Group B; DN = high-dose calcitriol; GVAX = Gene-Transduced Irradiated Prostate Allogeneic Cancer Cell Vaccines SWOG = Southwest Oncology Group. Di Lorenzo G. Drugs. 2007; 67:1109-1124; and Mendiratta P. Rev Urol. 2007;9:S9-S19 .

  4. Administration of Docetaxel • Docetaxel is available in 20-mg (0.5 mL) or 80-mg (2 mL) vials and requires dilution prior to use • The diluent contains 13% ethanol in water for injection • Docetaxel is infused through the vein for approximately 1 hour every 3 weeks

  5. Dose of Docetaxel • 75 mg/m2 IV every 3 weeks for 10 cycles • Give with 5 mg oral prednisone twice daily throughout treatment • throughout treatment • Premedicate with dexamethasone • Decrease or delay incidence of fluid retention and allergic reactions1 • Pretreatment regimen for hormone refractory prostate cancer is 8 mg dexamethasone at 12 hours, 3 hours,1 2 hours, and 1 hour before docetaxelinfusion2 • Docetaxel + prednisone given when neutrophil count is >1500 cells/mm3 IV = intravenous. 1. Piccart, M. J Clin Onc. 1997;15:3149-3155. 2. Dagher R, Li N, et al. Clin Cancer Research. 2004;10:8147-8151.

  6. Docetaxel Dosage to Manage Adverse Events Dagher R et al. Clin Cancer Res. 2004;10:8147-8151.

  7. Safety and Efficacy • Treatment of metastatic prostate cancer is palliative • Two phase 3 trials (TAX 327 and SWOG 9916) have shown improved 2 phase 3 trials (TAX 327 and SWOG 9916) have shown improved survival rate when using docetaxel • TAX 327 compared men who received Docetaxel every 3 weeks or weekly, men who received docetaxel every 3 weeks or weekly, with men who received mitoxantrone every 3 weeks. The docetaxel every 3 weeks arm had a median survival of 18.9 months vs versus16.5 months in the mitoxantrone arm (P = .009) • SWOG 9916 compared docetaxel plus estramustine and mitoxantrone plus prednisone; median survival was 17.5 months for the docetaxel arm and 15.6 months among the mitoxantrone arm (P = .02). ; median survival was 17.5 months for the docetaxel arm and 15.6 months among the mitoxantrone arm (P = 0.02) Petrylak D et al. N Engl J Med. 2004;351:1513-1520. Tannock I, et al. N Engl J Med. 2004;351:1502-1512.

  8. Maximize Benefits of Chemotherapy • Be aware of adverse effects and anticipate treatment as needed • Minimize nausea • Adjust to hair loss • Minimize fatigue • Be aware of peripheral neuropathy • Help patient establish a support network

  9. Potential Adverse Effects of Docetaxel • Leukopenia • Potential for fluid retention • Nausea and vomiting • Hair loss • Peripheral neuropathy • Diarrhea (drink plenty of fluids) • Fatigue (potentially from anemia)

  10. Adverse Effect: Leukopenia • Routine blood draws are taken to identify if WBC counts are low • Potential increased risk for infection • Monitor for fever WBC = white blood cells

  11. Adverse Effect:Fluid Retention • Medications • Dexamethasone (corticosteroid) has been seen to delay the onset of fluid retention by decreasing potential inflammation Piccart M. J Clin Oncol. 1997;15:3149-3155.

  12. Adverse Effect:Nausea and Vomiting • Eat small portions of food throughout day • Eat dry foods (eg, crackers or toast) • Avoid high-fat or greasy foods • Suck on ice chips or hard candy • Medications • Dexamethasone in combination with ondansetron

  13. Adverse Effect:Hair Loss • Usually temporary • Comb or brush hair gently • Use mild shampoo • Place sunscreen on scalp • Wear a hat when outside in the sun

  14. Adverse Effect: Peripheral Neuropathy • Patient education includes: • Be aware of thermal injury • Wear shoes to promote foot care • Examine bottom of feet daily • Report signs and symptoms of peripheral neuropathy to a healthcare provider Visovsky C et al. Clin J Oncol Nurs. 2007;11:901-913.

  15. Adverse Effect:Fatigue • Take scheduled rest breaks • Join a support group • Ask for help to accomplish activities • Exercise • Keep muscles conditioned • 2-site study examined resistance exercise program with a control and found men assigned to resistance exercise had less fatigue and higher quality of life than control group.* 2-site study examined resistance exercise program with a control and found men assigned to resistance exercise had less fatigue and higher quality of life than the control group Segal R. J Clin Oncol. 2003;21:1653-1659.

  16. Help Establish Support Network • Help patients identify trusting individuals to whom they canspeak openly about their disease • Offer a listing of surrounding support groups and resources • Involve family members and/or friends when appropriate

  17. Other Potential Adverse Effects • Patient may be receiving hormone therapy • May experience sexual dysfunction • Suggest medication (eg, sildenafil, tadalafil, and vardenafil) • Suggest open discussion with sexual partner to plan how to fulfill sexual desires • May experience hot flashes • Recommend comfort measures—cold/warm towels (taking in consideration for avoidance of potential thermal injury) (taking into consideration for avoidance of potential thermal injury) • Possibly prescribe medications (ie, gabapentin)

  18. Nursing Strategies to Prevent, Identify, and Manage Adverse Effects • Assist patient to schedule uninterrupted quiet/rest times • Provide comfort measures • Provide patient- and family-centered care • Provide education to patient and family • Be aware of patient’s concerns about treatment/adverse effects • Develop a plan of care and evaluate its effectiveness

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