Taxotere is administered intravenously. The word “intravenous” literally means “into the vein.” Drugs which are administered intravenously directly enter the bloodstream through a needle or tube which is inserted into a vein, most commonly in the arm or leg. This is called IV administration for short.
There are many reasons why drugs can be administered in this fashion. An IV transfusion allows for a medicine, usually diluted in a solution, to be released over a long period of time. Instead of an injection, in which all the medicine is inserted at once, an infusion or drip IV will slowly enter the body over a period of 5 minutes, an hour, or a whole day, depending on the patient's needs. On the other hand, IV administration also allows a medicine to enter the bloodstream directly, which makes it act more quickly than if the medicine had to be absorbed through the digestive tract. Finally, certain drugs can actually be destroyed by the enzymes and acid in the stomach, so they must be given intravenously to preserve their function.
Many chemotherapy drugs are given through IV drip due to this method's flexibility in controlling the dosage and the ease with which the body can absorb the drug. Other medications which can be given through IVs include pain medication, antibiotics, and drugs for low blood pressure.
Steps for IV Administration of Taxotere
As with any drug, there are many exact steps that should be taken by a nurse or oncologist in the storage and preparation of Taxotere. A patient's appointment will be regular (usually every 7 or 21 days), and the sequence of drugs will be set and explained prior to the first appointment.
Certain chemotherapy drugs, including Taxotere, can cause the body to retain fluid and swell in a condition known as edema. While the exact mechanism of this condition is still vague, the drugs can cause cells to “leak” fluid into the skin which is sometimes part of an allergic reaction. Many systems in your body contribute to the appropriate disposal of fluid, such as your lymphatic system and hormone (endocrine) system, and chemotherapy can inhibit the way these systems function.
In order to reduce an allergic reaction to chemotherapy drugs and thereby hopefully reduce swelling, corticosteroids are almost always prescribed in conjunction with Taxotere. Most commonly, a steroid called dexamethasone is taken twice a day for the three days prior to Taxotere administration.
Corticosteroids are naturally produced within the body by a gland near the kidneys. They help to regulate many functions within the body, such as
- Metabolism, or the process of assimilating of food and energy
- The balance of salt and water in the body
- Blood pressure
- Allergic reactions and inflammation
- Mood and behavior
Many of these functions are disrupted by chemotherapy drugs like Taxotere. The body uses the extra infusion of corticosteroids to support these functions and ideally mitigate some of the more severe side effects of the drug. For example, they can lessen inflammation, boost appetite, and reduce feelings of sickness and nausea during chemotherapy regimens.
Preparation of Taxotere Solution
There are two formulations of Taxotere which may be used in a patient's chemotherapy treatment. Older treatments of Taxotere came in two vials which were packaged together, one of which contained the docetaxel (active ingredient), stabilized with polysorbate 80, and the other containing a solution for diluting the drug of 13% ethanol in water. The nurse or doctor would then prepare the drug by combining these two elements and inverting the solution for approximately 45 seconds. The formulation should be clear and contain no pieces of material or discoloration.
The second step of this method of preparation is injecting this formulation into a carrier fluid, either of 9% sodium chloride solution or a 0.5% dextrose solution. The final concentration of Taxotere in fluid should be 0.3 to 0.74 milligrams per milliliter. This formulation is stable for up to four hours and should be used within that time period or discarded.
Now, Taxotere is usually sold as “Docetaxel Injection Concentrate,” which is pre-mixed and therefore simpler to administer. The new formula is a “single-dose vial of sterile, nonaqueous, clear yellow-to-brownish-yellow viscous solution.” The vials, which contain 20 milligrams, 80 milligrams, or 160 milligrams of docetaxel also contain polysorbate 80, ethyl alcohol, and water. This formulation is ready to be injected directly into a 9% sodium chloride solution or a 0.5% dextrose solution, like the previous formulation. The medication should still be present in the final infusion solution at a concentration between 0.3 and 0.74 milligrams per milliliter.
IV Infusion Reactions
The dosage a patient will be given is determined both by their type of cancer and by their body mass. After the solution has been prepared, it will be administered by IV line directly into a vein over the period of an hour. During and immediately after this infusion, there are a few things to look out for.
Some people may experience an immediate allergic reaction to the solution ranging from mild to severe. In fact, in some studies, up to 2% of people who take the drug suffer from toxic death after the administration of Taxotere. Allergic reactions requiring immediate medical attention include severe swelling of the face, lips, or extremities, hypotension (low blood pressure), erythema (generalized rash), or bronchospasm (narrowing of the airway and difficulty breathing). At the center where the drug is being administered, there must be facilities to treat any life-threatening conditions that may arise. If any of these reactions occur, treatment using Taxotere should be discontinued.
In addition, the Taxotere infusion contains ethanol, an alcohol used to dilute the drug since it is not soluble in water. This alcohol injected directly into the vein, can cause some people to feel intoxicated during and immediately after their treatment. It is, therefore, important to avoid drinking other alcohol during the day of treatment and even arrange transport from the hospital after treatment if a patient has a low alcohol tolerance.
Contraindications are certain pre-existing conditions that indicate that a drug or treatment should not be given. For example, people with some types of heart conditions should not take birth control pills because of potential complications and increased risk of heart attack. In the case of Taxotere, a few people should not be put on this chemotherapy regimen. This includes patients who
- Have a history of severe hypersensitivity reactions to polysorbate 80 or docetaxel
- Have a low neutrophil blood cell count (a particular kind of white blood cell that is highly affected and reduced as a side effect of Taxotere)
- Are pregnant or breastfeeding
- Have severe liver disease, because this increases the chance of toxic death during Taxotere administration
There are currently five different types of cancer that Taxotere is approved to treat. These include certain kinds of breast cancer, prostate cancer, gastric cancer, non-small cell lung cancer, and head and neck cancer. With each kind of cancer, different administration schedules are advised and additional chemotherapy or other medications are used in conjunction to maximize the drug's effectiveness. Doses may also depend on the patient's previous treatments of chemotherapy.
Taxotere Administration for Breast Cancer
There are two forms of breast cancer that can be treated with Taxotere. Locally advanced or metastatic breast cancer can be treated with Taxotere, administered every three weeks, over a period of an hour. The amount given ranges between 60 mg and 100 milligrams per meter squared of body surface area (mg/m2) . This is recommended if previous treatments of other chemotherapy drugs have failed.
Taxotere can also be used as part of a combination therapy for patients with breast cancer after (and sometimes before) surgery to reduce the chance of a resurgence. In this case, Taxotere is usually administered an hour after the chemotherapy drugs doxorubicin (brand name, Adriamycin) and cyclophosphamide. This is known as the TAC combination treatment and it is given once every three weeks for 6 cycles.
Taxotere Administration for Lung Cancer
For patients with lung cancer who have already undergone platinum-based chemotherapy, Taxotere can be used on its own, as a “monotherapy.” The dose is administered through IV once every three weeks for one hour at a rate of 75 mg/m2. For patients who have never undergone chemotherapy, Taxotere can be used in conjunction with the chemotherapy drug cisplatin, which is given immediately after the Taxotere infusion (once every three weeks).
Taxotere Administration for Prostate Cancer
Taxotere is used to treat prostate cancer which is spreading through the body despite previous rounds of hormone therapy treatment. The drug is administered in conjunction with the steroid prednisone, which decreases testosterone production and slows the growth of cancer cells. In this treatment, Taxotere is given at a rate of 75 mg/m2.
Taxotere Administration for Gastric Cancer
Patients suffering from a form of gastric cancer called adenocarcinoma may also take a three-drug chemotherapy combination which includes Taxotere. Every three weeks, the patient will receive 75 mg/m2 of Taxotere during a one hour IV infusion. Immediately after, they are given an infusion of cisplatin, followed by a five-day, continuous IV infusion of fluorouracil. The patient will take an anti-nausea medication before this treatment is begun and may be hydrated with IV fluids.
Taxotere Administration for Head and Neck Cancer
Taxotere is used in combination with two other chemotherapy drugs to treat a particular form of inoperable cancer known as Squamous Cell Carcinoma of the Head and Neck (SCCHN). The drug therapy is then followed by radiation treatments to increase its effectiveness. Similar to the way Taxotere is used to treat gastric cancer, with SCCHN, Taxotere is given in an intravenous infusion at a rate of 75 mg/m2 over the period of one hour. This is followed by an infusion of cisplatin, then a five-day infusion of fluorouracil. This should be given once every three weeks for four cycles.