1. What is docetaxel?
2. When is docetaxel given?
3. Before starting docetaxel?
4. How is docetaxel given?
5. Side effects of docetaxel
6. Allergic reaction
7. Blood clots
8. Sex, contraception and pregnancy
9. Travel and vaccinations
10. Further support
Docetaxel is a chemotherapy drug. Chemotherapy is a treatment that destroys cancer cells using anti-cancer drugs. Docetaxel is the non-branded name of the drug, but you may hear it called by one of its brand names such as Taxotere.
Primary breast cancer
Docetaxel is used to treat primary breast cancer (cancer that has not spread beyond the breast or the lymph nodes under the arm) in combination with other chemotherapy drugs.
Docetaxel can be given before surgery to shrink a larger breast cancer. This may mean breast-conserving surgery is an option, rather than a mastectomy. Or it might be given before surgery to slow down the growth of a fast-growing breast cancer and reduce the chance of it spreading to other parts of the body.
When chemotherapy is given before surgery it’s called primary or neo-adjuvant chemotherapy.
Docetaxel is given after surgery to reduce the risk of breast cancer coming back in the future. It usually starts within a few weeks of your operation. If you are going to have radiotherapy you will usually complete your course of docetaxel first.
When chemotherapy is given after surgery it is called adjuvant therapy.
Breast cancer that has spread
Docetaxel is used alone or with other chemotherapy or anti-cancer drugs to treat breast cancer that has:
- Spread to the tissues and lymph nodes around the chest, neck and under the breastbone (known as regional recurrence or locally advanced breast cancer)
- Spread to other parts of the body (secondary breast cancer)
Before starting your treatment most hospitals will arrange a chemotherapy information session. At this appointment a nurse will discuss how and when you will have your chemotherapy and how side effects can be managed.
You may have blood tests and some people may have an ECG (electrocardiogram), a simple test that checks your heart rhythm. Your height and weight will also be measured, this is needed to work out the correct dose of chemotherapy for you.
You’ll be given contact numbers so you know who to phone if you have any questions or concerns.
Docetaxel is given into a vein (intravenously). This will usually be as a drip, also called an infusion, into the hand or arm.
Other intravenous methods may be used depending on factors such as how easy it is for chemotherapy staff to find suitable veins, and your preferences.
Docetaxel is normally given once every three weeks, over about one hour. This is known as a cycle.
The interval between each treatment gives your body time to recover. This may vary depending on whether the number of blood cells has returned to normal between each cycle.
You will have docetaxel as an outpatient.
Before each cycle you will be given medication to reduce the chances of any possible reactions.
How long will I have docetaxel for?
For primary breast cancer three to six treatment cycles are usually given.
For locally advanced and secondary breast cancer the number of cycles will vary depending on the individual.
Like any treatment, docetaxel can cause side effects. Everyone reacts differently to drugs and some people have more side effects than others. These side effects can usually be managed and those described here will not affect everyone.
If you are concerned about any side effects, regardless of whether they are listed here, talk to your chemotherapy nurse or cancer specialist (oncologist) as soon as possible.
If you are being given other chemotherapy or anti-cancer drugs with docetaxel, you may have additional side effects from these drugs.
Common side effects
Docetaxel can temporarily affect the number of healthy blood cells in the body. You will have regular blood tests throughout your treatment to check your blood count. If the number of blood cells is too low, your next course of treatment may be delayed or the dose of the chemotherapy reduced.
Risk of infection
When the white blood cells fall below a certain level, it’s known as neutropenia. Not having enough white blood cells can increase the risk of getting an infection. Your resistance to infection is usually at its lowest point around 7–14 days after the docetaxel has been given. The number of white blood cells usually returns to normal before your next course of chemotherapy is due.
Your treatment team may give you guidelines to follow for reporting signs of an infection, but generally you should contact your hospital immediately if you experience any of the following:
- You have a high temperature (over 37.5°C) or low temperature (under 36°C), or whatever your chemotherapy team has advised
- You suddenly feel unwell, even with a normal temperature
- You have any symptoms of an infection, for example a sore throat, a cough, a need to pass urine frequently or feeling cold and shivery
Before starting chemotherapy your treatment team should give you a 24-hour contact number or tell you where to get emergency care.
You may need antibiotics.
Your doctor might recommend injections of drugs called growth factors. This helps the body produce more white blood cells to reduce your risk of infection.
Having too few red blood cells is called anaemia. If you feel particularly tired, breathless or dizzy, let your treatment team know.
Bruising and bleeding
You may bruise more easily, have nosebleeds or your gums may bleed when you brush your teeth. Tell your treatment team if you experience any of these symptoms.
Docetaxel causes hair loss. Most people will lose all their hair, including eyebrows, eyelashes and body hair.
You may begin to lose your hair about two weeks after the first treatment, but it can happen earlier. Hair loss is usually gradual but it can happen very quickly, possibly over a couple of days.
Scalp cooling may stop you losing some, or all, of the hair on your head.
Any hair loss should be temporary and in most cases your hair will begin to grow back a few weeks after your treatment has ended.
There’s some evidence that docetaxel treatment may result in prolonged or permanent hair loss. Permanent hair loss is described as incomplete regrowth of hair six months or more after completing treatment. There’s currently no definite evidence to say how often this happens.
If you’re concerned about hair loss when making decisions about treatment, talk to your oncologist and breast care nurse.
Numbness and tingling in hands or feet
People having docetaxel may have pain, numbness or tingling in their hands and feet. This is due to the effect of docetaxel on the nerves and is known as peripheral neuropathy.
If you have tingling or numbness (such as difficulty doing up buttons, or difficulty feeling the difference between hot and cold water with your fingertips), mention this to your treatment team so they can monitor your symptoms.
Painful muscles and joints
Your muscles or joints may ache or become painful two to three days after you have your treatment. This usually wears off after a few days to a week but may last a bit longer for some people. It can be very painful and you may need to take pain relief or anti-inflammatory drugs such as ibuprofen. It’s a good idea to have some of these available before starting your treatment just in case you need them. Be aware that pain relief such as paracetamol or ibuprofen can mask the signs of infection.
Before using anti-inflammatory pain relief, ask your doctor about the correct dose, how long you should use it for and any possible side effects, especially if you have a stomach ulcer or asthma.
Nausea and vomiting
Nausea (feeling sick) is usually mild and most people will not actually vomit (be sick).
You may start to feel unwell a few hours after your treatment. You’ll be given anti-sickness medication, as tablets or into a vein, before each cycle of chemotherapy. You’ll also have some anti-sickness tablets to take home.
If nausea and vomiting are affecting you, let someone in your treatment team know.
Contact your hospital if you have severe vomiting and cannot drink any fluids without vomiting, even if it happens at the weekend or during the night.
You may develop a build-up of fluid in the body (oedema), which can take a few weeks to go away. This can appear as swollen ankles and legs and feeling short of breath.
You’ll be given steroid drugs to prevent an allergic reaction to docetaxel, which will also help reduce the chance of fluid building up.
You may develop a rash anywhere on your body or your skin might discolour. This could be red and itchy or you may feel flushed. Your doctor might prescribe medicine to help.
If you have skin reactions, mention this to your treatment team when you see them next so they can monitor your symptoms.
Some people have a skin reaction called hand-foot syndrome, often called Palmar-Plantar syndrome. It usually affects the palms of the hands and soles of the feet, but you may also have symptoms in other areas such as the skin on the knees or elbows.
Docetaxel may cause changes to the appearance of your nails on your fingers and toes. This can be a change in the nail colour or texture, such as ridges forming. Nails can become more brittle and cracked. Occasionally the nail may lift off the nail bed and fall out, but nails will grow back.
As you’re more at risk of infection while having chemotherapy, report any signs of infection such as redness, heat, swelling or pain in or under your fingernails and toenails to your treatment team.
Your mouth may become sore and small ulcers can develop. You’ll usually be given mouthwash to reduce the risk of a sore mouth developing. If you do get a mouth infection your specialist or chemotherapy nurse can advise you about different mouthwashes or suitable medicine.
It’s advisable to see your dentist for a check-up before chemotherapy begins, and to avoid dental treatment during chemotherapy if possible.
While you are having docetaxel, your sense of taste can change and some foods may taste different, such as more salty, bitter or metallic. You may no longer enjoy some of the foods you used to. If this is the case speak to your treatment team – they may be able to suggest ways of managing this. Your taste should return to normal once your treatment has finished.
Diarrhoea or constipation
You may have diarrhoea or constipation. Your chemotherapy team can prescribe medicine to help control it and can give you information about diet.
Contact your chemotherapy team if you have four or more episodes of diarrhoea within 24 hours.
Fatigue (extreme tiredness)
You may become extremely tired during your treatment. For some people, this fatigue can last for several weeks or even months after the treatment has finished. There are some things that can help improve fatigue – your treatment team may be able to help you with this.
Effects on your concentration
Some people find treatment affects their ability to concentrate and makes them more forgetful. This is sometimes referred to as ‘chemo brain’ or ‘chemo fog’, but your treatment team may call it cognitive impairment. It usually improves over time after treatment has finished.
Pain in the injection site
Pain can occur where the needle has been inserted or anywhere along the vein. Tell your chemotherapy nurse immediately if you have pain, stinging or a burning sensation around the cannula (small plastic tube) while the drug is being given.
If docetaxel leaks out of the vein it is being given in (called extravasation), it can damage the surrounding tissue.
After treatment, you may have pain where the needle was inserted, or along the vein. After a few weeks you may notice tenderness, darkening and hardening around where the needle was inserted. This should fade in time.
Effects on fertility
It’s not known exactly what effect docetaxel has on fertility. However, any effects will also depend on other chemotherapy drugs you are having at the same time or have had in the past, and your age.
If you’re concerned about your fertility, talk to your treatment team before treatment begins.
Less common side effects
Changes in heart rate and blood pressure
Docetaxel can alter your heart rate and affect blood pressure so you will be carefully monitored for this during your treatment. Changes to your heart rate and blood pressure can usually be treated easily and you will not have to stop your treatment. This is not the same as having an allergic reaction to docetaxel (see below).
Effects on the lungs
This may include scarring or inflammation of the lung tissue. This is a rare side effect, but if you become breathless or develop a dry cough during or in the few weeks after your treatment, let your treatment team know.
Before your treatment starts you will be given drugs called steroids to reduce the risk of an allergic reaction. These are usually given as tablets to take for three days starting the day before each cycle of chemotherapy. Take these as directed by your treatment team and do not stop taking them without talking to the team first.
If you have an allergic reaction to docetaxel, it will probably happen within the first few minutes of your treatment. It’s most likely the first or second time you have the drug. Reactions can vary from mild to severe, although severe reactions are uncommon.
You’ll be monitored closely during your treatment so that any reaction can be dealt with immediately.
Symptoms of an allergic reaction include:
- Skin rash
- Back pain
- Shortness of breath
- Fever or chills
If you have a severe reaction, treatment will be stopped immediately and you may not be given docetaxel again.
People with breast cancer have a higher risk of blood clots. Their risk is higher because of the cancer itself and some treatments for breast cancer. If the cancer has spread to other parts of the body (secondary breast cancer), this also increases the risk.
Having docetaxel increases the risk of blood clots such as deep vein thrombosis (DVT). People with a DVT are at risk of developing a pulmonary embolism (PE). This is when part of the blood clot breaks away and travels to the lung.
Blood clots can be harmful but are treatable so report symptoms as soon as possible.
If you experience any of the following symptoms contact your local A&E department, GP or treatment team straight away:
- Pain, redness/discolouration, heat and swelling of the calf or thigh
- Swelling, redness or tenderness where a central line is inserted to give chemotherapy, for example in the arm, chest area or up into the neck
- Shortness of breath
- Pain or tightness in the chest
- Unexplained cough or coughing up blood
You’re advised not to become pregnant while having treatment because docetaxel can harm a developing baby. If you haven’t been through the menopause, talk to your team about the most suitable method of contraception for you. It’s still possible to become pregnant even if your periods become irregular or stop.
You can still have sex during treatment. It’s thought that chemotherapy drugs cannot pass into vaginal fluids or semen, but this cannot be completely ruled out as chemotherapy drugs can pass into the blood and some other body fluids. Most hospital specialists will advise using barrier methods of contraception, such as condoms, during treatment, and for a few days after chemotherapy is given.
If you’re planning a holiday or need to travel overseas, check with your treatment team first.
You should not have any live vaccines while you are having chemotherapy. Live vaccines include mumps, measles, rubella (German measles), polio, BCG (tuberculosis), shingles and yellow fever.
Live vaccines contain a small amount of live virus or bacteria. If you have a weakened immune system, which you may do during chemotherapy, they could be harmful.
It is safe to have these vaccines six months after your chemotherapy finishes. Talk to your GP or treatment team before having any vaccinations.
If someone you have close contact with needs to have a live vaccine speak to your treatment team or GP. They can advise what precautions you may need to take depending on the vaccination.
Anyone at risk of a weakened immune system, and therefore more prone to infection, should have the flu vaccine. This includes people due to have or already having chemotherapy. The flu vaccine is not a live vaccine so does not contain any active viruses. Talk to your chemotherapy specialist or breast care nurse about the best time to have your flu jab.
Your chemotherapy team and breast care nurse can help with any questions you have. You can also call us free on 0808 800 6000 for information and support.
On our online Forum, you can find people going through treatment at the same time as you on the monthly chemotherapy threads.