As with most chemotherapy drugs, Taxotere carries a long list of side effects, ranging from mildly annoying to debilitating and extreme. The majority of the side effects experienced by those who are given Taxotere are actually common to most chemotherapy treatments.
How Side Effects Are Determined
Generally, side effects for drugs are determined by feedback that patients during clinical trials give to their doctors. Every complaint that a patient notes during their participation in the trial, regardless of whether they are taking the drug, a placebo or a control regimen, is compiled into a list which is used to create a list of possible side effects. It is important to note, therefore, that it can be hard to know whether a condition or pain experienced by someone taking the drug is a direct result of that drug, or if it just happened to occur simultaneously. Restated, it is hard to always know if there is a causal or simply a correlation between the effect and the drug.
The Food and Drug Administration (FDA) tries to accumulate all possible side effects to understand potential risks before releasing the drug on the market. On one hand, because of the vast list usually associated with drugs with high toxicity (anywhere between 50 to 500 side effects may be listed on the full label of a chemotherapy drug), it is common for people to only experience a small range of side effects. On the other hand, sometimes people experience effects that were not previously associated with the drug at all. These are known as “adverse events.”
The FDA sponsors a telephone line which people taking prescription drugs can call in order to report these adverse effects or events. In fact, all prescription medication as well as over-the-counter medication must include the toll free number for MedWatch on its packaging. Severe adverse events may also be reported online. If a complaint is particularly severe and reported multiple times, it may cause the drug to go off the market.
Why Does Taxotere Have So Many Side Effects?
Like many chemotherapy drugs, Taxotere works by attacking cells which grow and divide quickly in the body. Cancer cells are cells with gene mutations which allow for unchecked and rapid growth and division. Thus, drugs which aim to reduce cancerous masses within the body are usually targeted at processes within the cell that incite growth and replication.
Unlike radiation or surgery, chemotherapy cannot be targeted at one place in the body. When a patient ingests a drug or it is injected into their veins, the drug will inevitably travel to all parts of the body, attacking cell growth and division indiscriminately. Any cells in the body which divide particularly quickly are therefore more strongly affected.
Nerve and brain cells, for instance, divide comparatively slowly, making them relatively capable of withstanding the effects of chemotherapy. In contrast, blood cells, hair follicle cells, and cells in mucous membranes coating the mouth, stomach, and bowel are replaced frequently by new cells and are all particularly affected by chemotherapy. Thus, many of the side effects associated with chemotherapy stem from low blood counts and issues with mucous membranes which are unable to successfully regenerate themselves in the body.
Side Effects During Injection
When Taxotere is first injected, some patients may experience “acute” or immediate reactions to the drug. In order to avoid or diminish these initial allergic reactions, patients will be given steroids a day or two before the injection and possibly 30-60 minutes right before intravenous administration of Taxotere commences. Even with these steroids, however, patients may experience classic symptoms of allergic reaction within minutes to hours of the injection such as
- Wheezing, coughing, and shortness of breath
- Swelling of the face and lips, flushing of the face
- Spreading rash or itchiness
- Pain in the stomach, back or chest
- Pain at the injection site
Acute reactions, like all sudden allergic reactions, can be uniquely dangerous. The National Center for Biotechnology Information estimates that “Even with premedication, approximately 2% of patients will experience potentially life-threatening reactions.” It is therefore extremely important for a patient to notify a nurse or doctor immediately as soon as they begin to experience any of these effects during the intravenous injection of Taxotere. Even if a patient has not experienced these reactions during the first round of drug injections, they may develop them over time, so it is important to stay vigilant for these symptoms every time a patient receives the drug.
Side Effects of Taxotere
As with much of medicine, most side effects have a technical name by which they are categorized in the medical profession. Often, people will describe these side effects in more common terms which are then translated into jargon by doctors. Here, both technical and common terms are used, along with an explanation of the mechanism behind the side effect.
Blood Count Disorders from Taxotere
Since blood cells tend to grow and divide quickly, chemotherapy treatments such as Taxotere often attacks these cells. Blood cells of all types are produced in the bone marrow, which is affected by chemotherapy. This reduces the body's ability to replenish the blood supply with vital components that keep the body resilient and carry oxygen, nutrients, hormones, and waste to and from other cells.
Febrile Neutropenia, or Low Neutrophil Cell Count
This is the most common side effect of Taxotere. Neutrophils are the most common kind of white blood cell in the human body. They are part of the body's defense or “immune” system and attack bacteria that causes infection. Although having a low neutrophil cell count alone will not hurt someone, it leaves the body open to infection and reduces the body's ability to fight bacteria. Therefore symptoms caused by infections such as fever, ulcers, abscesses, rashes, and slow-healing wounds are all associated with febrile neutropenia.
Anemia, or Low Hemoglobin or Red Blood Cell Count
Anemia is a condition caused by reduced red blood cells and/or hemoglobin in the blood stream. These components are responsible for carrying and delivering oxygen to different parts of the body, so, in their absence, organs and cells become starved for oxygen. This can lead to fatigue, loss of energy, rapid heart rate, and shallow, quick breathing especially during exercise. It can also cause pale skin, insomnia, and cramping in the extremities.
Thrombocytopenia, or Low Blood Platelet Count
Blood platelets have the important function of helping your blood to clot when necessary. Sometimes patients who receive Taxotere will develop thrombocytopenia, a condition in which your blood does not contain enough platelets. This can lead to sudden bleeding such as from the nose or gums. In addition, people might experience unexplained bruising, heavy menstrual flow, headaches, or small red and purple spots on the skin called petechiae.
The gastrointestinal tract, the organs which take in, digest, and expel food, are lined with a film of “epithelial cells.” These cells form a film of mucus that both protects tissue from the gastrointestinal enzymes which break down food and helps lubricate the lining to pass food through the tract. This lining is often depleted during regimens containing Taxotere, causing multiple painful side effects. Mucositis, the condition in which the mucus membrane is deficient, can lead to painful sores or ulcers in the mouth, throat, stomach, and bowel. The mouth is one of the most vulnerable parts of the gastrointestinal tract and may therefore exhibit the most side effects, such as pain, inability to eat, difficulty swallowing, chewing, or talking, dryness, burning, and patches of pus on the tongue and mouth. These oral symptoms may also contribute to weight loss during chemotherapy.
Acral Erythema, or Skin Toxicity
Although researchers are not exactly sure why, sometimes chemotherapy drugs can cause painful redness and peeling of the hands and feet. It can begin with tingling and progress to tenderness, blistering, and shedding of skin in a process called “desquamation.” The symptom usually occurs on the palms of the hands and the soles of the feet and can make it painful to walk or grip objects.
Various issues involving the nails can also result from chemotherapy, including discoloration, brittle or easily breakable nails, splintering of the nail or, in some cases, complete separation of the nail from the nail bed in a condition called "onycholysis." Sometimes, to help prevent this side effect, doctors will implement frozen gloves and socks during the intravenous injection of Taxotere which reduces blood flow to the hands and feet and has been shown in some studies to reduce side effects on nail growth and health.
Edema, or Fluid Retention
A common complaint associated with the effects of Taxotere includes swelling of the extremities. Due to a buildup of fluid in the body. Although the exact mechanism or cause of this side effect is unknown, it may be due to increased permeability in the capillaries, the tiny branching blood vessels that stem out from main veins. Edema usually begins in the lower extremities such as the feet, ankles, and legs, but can spread to many parts of the body. Cystoid Macular Edema (CME) is a particular variety of edema that affects the eyes. Cyst-like pockets of fluid can build up in the eye, causing blurriness and impairment of the central field of vision. It is usually painless.
Alopecia, or Hair Loss
As with most chemotherapy drugs, patients who take Taxotere are likely to experience some level of hair loss. This occurs because hair follicles are one of the fastest growing cells in the body and thus particularly vulnerable to Taxotere's mechanism of destroying cells during division. Patients lose not only the hair on their scalps, but their eyelashes, pubic hair, facial hair, and hair on the extremities. While hair loss is an almost university effect of chemotherapy treatment, in almost all cases, hair begins to regrow after treatment has been completed. Taxotere, however, has been associated with permanent alopecia, meaning that the hair may never regenerate for the remainder of a patient's life. This emotionally difficult side effect of the drug was not originally conveyed on the FDA label, and has been the subject of much litigation and protest.
Peripheral Neuropathy, or Nervous System Disorder
This is one of the more common, serious, and lasting possible side effects of Taxotere. The drug can damage either sensory or motor nerves, and sometimes both. “Peripheral” means that the damage affects nerves which are far from the main nerve control centers of the body, the spine and the brain. Neuropathy most often affects the hands and feet of Taxotere patients. Since motor and sensory nerves allow the body to interact with the world successfully, patients with damaged nerves may experience a whole host of symptoms, including weakness, numbness, tingling, or burning in the hands and feet, pain, loss of balance, and inability to perform tasks which require fine motor skills, such as fastening jewelry, cutting vegetables, or buttoning clothing. Since the peripheral nervous system controls bladder and bowel function, patients may also experience incontinence or constipation associated with neuropathy.
Less Common Side Effects of Taxotere
Along with the preceding list of side effects, many more less common side effects are possible. Some of these are associated with the previous conditions or may arise from a combination of multiple conditions caused by Taxotere. According to the Mayo Clinic, these include, but are not limited to,
- Body aches or pain
- Dry, red, hot, or irritated skin at the injection site
- Pain, swelling, or lump under the skin at the injection site
- Pain in the joints or muscles
- Runny nose
- Tender, swollen glands in the neck
- Burning, dry, or itching eyes
- Burning upper abdominal or stomach pain
- Discharge from the eyes
- Excessive tearing
- Redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid
- Rapid breathing
- Wrinkled skin
- Black, tarry stools
- Blood in the urine or stools
- Difficult or painful urination
- Fever or chills
- Lower back or side pain
- Noisy, rattling breathing
FDA Black Box Warning
Perhaps of most concern is the black box warning associated with the drug. This kind of warning is the FDA's most extreme and signals conditions which are possibly life-threatening. In the case of Taxotere, a few side effects may affect patients so strongly that they can be fatal. These include severe anaphylactic allergic reactions to the drug, which up to 2% of patients experience during administration and severe edema or swelling which can restrict breathing. In addition, up to 2% of patients with normal liver function experience what is known as “toxic death,” in which the body cannot process the toxicity of the chemotherapy drug. In patients with abnormal liver function, the percentage who experience toxic death jumps to 11.5%.
Informing Patients of Side Effects
When people are diagnosed with life-threatening illnesses, they are often willing to accept the pain, discomfort, and embarrassment of the side effects of chemotherapy like Taxotere without a second thought. It is vital, however, for patients to understand the risk they are undertaking when they choose to submit themselves to this treatment. The FDA must clearly label drugs with all possible side effects, and oncologists, doctors specializing in the treatment of cancer, should thoroughly explain both common and uncommon side effects to patients who are considering Taxotere.