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Taxotere is presently the most active chemotherapeutic agent in prostate cancer. Two large randomized studies showed longer survival with Taxotere. Taxotere has a basic role to play in treating men with advanced metastatic disease. Taxotere can be used as a single agent or combined with other medications such as Carboplatin, Xeloda or Avastin plus Revlimid.
Taxotere is administered intravenously. There are two popular administration schedules. The first is to use a larger dose administered every three weeks. The second employs a lower dosage administered weekly. In more advanced cases, studies seem to indicate that the every three week protocol is more effective. However, the larger doses causes more frequent problems with low blood counts and a greater fatigue. Low white counts can be counteracted with other medications such as Neulasta or Leukine. Typically younger men are started on the every three week protocol. If tiredness is excessive, the program can be changed to weekly administrations. Men who are weaker or more elderly often begin with the weekly protocol.
Side-effects of Taxotere vary. Reversible hair loss tends to be more severe using the three week schedule. Nausea is not very common because anti-nausea medicines are so effective. Taxotere can affect the taste buds making food taste funny. “Icing the tongue” by keeping ice chips in the mouth during the infusion is advisable during treatment and continuing afterward for an additional hour.
Weakening of fingernails is more frequent with the once-a-week Taxotere schedule. For this reason the finger tips should be “iced” during the infusion. Irritation of the tear ducts occurs more commonly with weekly Taxotere. We recommend artificial tears during and after each treatment. However, it may be necessary to place a temporary spacer in the tear ducts to avoid long-term scarring.
Another side effect is neuropathy. Neuropathy is numbness in the fingers and toes. Generally these symptoms will slowly reverse over time after the Taxotere is stopped. High doses of Glutamine, an amino acid, can minimize the severity of the neuropathy. Other rare side-effects include: rash, liver inflammation or diarrhea.
Overall Taxotere is well-tolerated. We published a pilot trial in 2001 evaluating the tolerability of Taxotere in elderly men. The average age of the study group was 78. The oldest was 87. In that study 17 out of 20 men completed a full course of therapy. The three men who decided to stop the treatment because they felt tired.
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