Taxotere is approved by the FDA for the treatment of breast, lung, prostate, gastric, and head and neck cancer. Taxotere in the treatment of breast cancer, however, is unique because it is used to combat early stages of the disease. With all four other cancers on this list, Taxotere is only used as a second line or palliative treatment option. This means that other drugs, radiation, and/or surgery have failed to cure the patient, or the disease has already progressed past the point of long-term recovery. For this reason, patients with these cancers who receive Taxotere do not often survive to experience the long-term effects of the drug. Only breast cancer patients, who may receive Taxotere in relatively early stages of their disease, are exposed to the possibility of having to live with permanent hair loss. Most lawsuits against the company which manufactures Taxotere, Sanofi-Aventis, Inc., are, therefore, filed by women who have had breast cancer.
Types of Breast Cancer Treated with Taxotere
Different kinds of cancer have different associated courses of treatment, and it is important to remember that every case of breast cancer has its own unique profile. This makes it difficult to prescribe hard and fast rules to the treatment of any class of cancer.
Breast cancer which has not spread, such as ductal carcinoma in situ (DCIS), is most often treated locally with surgery and/or radiation therapy. A lumpectomy, in which the lump and a margin of tissue surrounding it is removed, may be performed, alone or followed by radiation. Alternatively, a doctor may advise a mastectomy, in which an entire breast is removed and possibly reconstructed later with plastic surgery. In this case, radiation is usually not administered. Chemotherapy is not commonly used as a treatment for noninvasive breast cancer unless the lump tests positive for hormone receptors. Taxotere is not used in these chemotherapy regimens.
The two most common forms of invasive breast cancer, ductal carcinoma (IDC) and lobular carcinoma (ILC) may be treated with and the combination of surgery, radiation, and/or chemotherapy. Unlike radiation and surgery, chemotherapy is a systemic treatment, meaning that it targets all cells in the body that grow and divide rapidly. Since these two types of cancer are, by definition, infiltrating different parts of a patient's body, they necessitate a systemic approach that will attack any cancerous cells which have spread undetected from the main point of origin. There are many variations of chemotherapy regimens which may be advised for particular cancers, some of which include Taxotere. Almost all chemotherapy treatment options for invasive breast cancer include multiple drugs administered in succession for one day every 1-3 weeks. This treatment continues in cycles for 3 to 6 months to complete one course of chemotherapy.
Various factors will determine which series of chemotherapy drugs will be given to a patient. One of the most common and dangerous concerns associated with many forms of chemotherapy is cardiac toxicity. Cardiac toxicity is a broad term for many different kinds of heart damage that may stem from chemotherapy treatments. Patients can develop
- Cardiomyopathy, a condition in which the muscle of the heart becomes “weakened, enlarged, thickened, or stiff,” causing cardiac arrhythmia or failure
- Myocarditis, in which the heart is inflamed or swollen
- Pericarditis, in which the sac around the heart becomes inflamed leading to chest pain and possible heart failure
- Acute coronary syndromes like chest pain or heart attack, caused by damage to the blood vessels and a decreased level of blood flowing to the heart
- Congestive heart failure, in which the heart, weakened, cannot pump sufficient blood throughout the body
Because of these serious conditions that may develop, cardiac toxicity is one of the determining factors in deciding which kinds of drugs should be given to which patients. Some drugs have more aggressive effects on the heart and should be avoided. For example, patients with a personal or family history of heart disease will most likely not be given drugs which are particularly known for affecting or weakening the heart. Age, general health, the tumor's growth rate, tumor characteristics, and genetic markers which can be tested for may also affect which kinds of drug your doctor or oncologist recommends.
Taxotere itself does not cause cardiac toxicity, but it is often used in conjunction with drugs that do. Chemotherapy compounds which are known to cause cardiac toxicity include the anthracycline drugs daunorubicin, doxorubicin, epirubicin, idarubicin, and valrubicin. Cyclophosphamide, an alkylating agent, can sometimes also contribute to this result. Some targeted therapies can cause heart damage, including trastuzumab, bevacizumab, lapatinib, sunitinib, and sorafenib. Drugs from this list that are commonly used in the treatment of breast cancer include doxorubicin, cyclophosphamide, and trastuzumab. For this reason, alternatives to drug regimens including these particular compounds are often developed to mitigate the potential heart damage for patients with higher cardiac risk.
Taxotere Drug Regimens for Breast Cancer Treatment
Even when doctors are considering using Taxotere to treat patients, they must decide which drugs to administer in tandem and define an appropriate schedule. There are a few common treatment options which use the chemical compound docetaxel (Taxotere) as a main component.
TAC, AC-T, TC, or AC
TAC is one of the most common drug regimens given to women with localized breast cancers. AC-T, TC, and AC are variations of this combination in which one drug is left out or the order is rearranged for a particular reason. This shorthand stands for the three drugs Taxotere (docetaxel), Adriamycin (doxorubicin), and Cytoxan (cyclophosphamide). The names in parenthesis are the generic names of the compounds which are active ingredients in the marketed medicines. This regimen is most often administered as
- 75 milligrams of Taxotere per meter squared of body area, given to the patient in an IV drip over the period of one hour, followed by
- 50 milligrams of Adriamycin per meter squared of body area, administered through a slow intravenous bolus lasting 3 to 10 minutes, concluded by
- 600 milligrams of Cytoxan per meter squared of body area, given to the patient either through IV drip or intravenous bolus.
The three treatments will occur in rapid succession, every 21 days or three weeks, for up to six cycles, depending on the oncologist's recommendations and the cancer's stage.
When a patient has a heart condition or the physician suspects that their heart will not be able to handle stress due to their medical history, family history, or age, TC becomes a better option. Adriamycin is in a class of chemotherapy drugs called anthracyclines. These drugs are associated with cardiotoxicity or heart failure, the chance of which is increased if the patient has a preexisting condition or weak heart. Although the heart may perform well during the rounds of chemotherapy, chronic heart failure may occur months or even years after the treatment.
Refining TAC Treatments
New studies are constantly refining and changing the way that these particular chemotherapy drugs are administered and for what conditions. Currently, AC-T and TAC are considered more aggressive chemotherapy options than TC. For this reason, they are recommended for patients with more abnormality in their cancer cells, more quickly growing cancers and cancers with a high chance of recurrence. Often, women can participate in this decision with their doctor. A large-scale study published in 2015 in the Journal of the American Medical Association Oncology determined that AC-T is the most effective treatment sequence in early stage breast cancer when used with other methods like surgery and radiation. Other studies agree, but argue that AC-T carries more toxicity risk which makes alternatives attractive.
TC, TH, or TCH
These three groupings are another common treatment option including Taxotere which breast cancer patients may have undergone. The acronym stands for Taxotere (docetaxel) or Taxol (paclitaxel) followed sometimes by carboplatin, followed in certain circumstances by Herceptin (trastuzumab). Carboplatin is a platinum-based chemotherapy which works by binding dividing cells' DNA together to prevent it from successful duplication.
Herceptin works slightly different than most of the chemotherapy drugs used in the treatment of breast cancer. It is a targeted therapy, meaning that its scope is more limited. Instead of attacking all cells in the body which divide quickly, this therapy is a monoclonal antibody, meaning that it targets the protein human epidermal growth factor 2, or HER2. Because of this particular focus of this drug, it is commonly used to treat HER2 positive cancers.
It is important to note that, with this treatment, the taxane or “T” in the combination can be either Taxotere (docetaxel) or Taxol (paclitaxel). This means that Taxotere is not a necessary component of this combination of chemotherapy.
Occasionally, carboplatin will be omitted and a targeted therapy, another monoclonal antibody called Perjeta (pertuzumab) will be added to the treatment, creating the combination THP. This particular combination is usually used as a neoadjuvant therapy, meaning that it is given before surgery to reduce the size of the tumor. Additionally, it is given to patients with HER2 positive breast cancer which have spread throughout the body.
A third option which may be recommended for the treatment of certain breast cancers is FEC plus Taxotere (docetaxel) and sometimes accompanied by the targeted therapy drugs, Perjeta (pertuzumab) and Herceptin (trastuzumab). The FEC part of this treatment stands for Fluorouracil, Epirubicin, and Cyclophosphamide. As with TCH treatments, Taxol (paclitaxel) can be used as an alternative to Taxotere (docetaxel) in this regimen.
A study in 2005 suggested that this particular treatment might cause significant improvement in survival rates only for women over 50, who had node-positive breast cancer, meaning that the cancer had spread from its point of origin into the lymph nodes of the patient. However, this regimen was shown to be as effective for women under 50 as the other standards of treatment. Additionally, this particular combination of drugs is most often used as a neoadjuvant treatment, given before surgery to shrink the tumor and make the operation more successful.
Choosing a Chemotherapy Treatment
Treatments for breast cancer have been evolving for over a century, and, today, there are dozens of combinations of drugs, radiation, and surgery that might be considered as options for the treatment of an individual's disease. These many options represent a growing concern for treating the prevalence of breast cancer and will hopefully lead to less toxic, more nuanced and effective therapies over time.
In 2009, a study published on the website for the National Center for Biotechnology Information, summed up the state of research in breast cancer treatment. The author wrote, “There is currently no one gold standard regimen in early-stage breast cancer. The proliferation and diversity of trials, with varying interpretations of the standard of care, has led to endless conjecture on the best treatment, and much discussion of the route by which the ‘latest' regimen to be tested has evolved.”
For now, each option presents its own set of risks and rewards, which a doctor should discuss with each breast cancer patient. It is true that a physician will have a much clearer idea of current research, an understanding of particular side effects a drug might have on a certain case of breast cancer depending on the patient's personal profile, and their own experience which might give them a preference for a certain kind of treatment. It is also true, however, that doctors may be pressured by hospitals or pharmaceutical companies to favor one kind of drug over another due to cost, hospital protocol or benefits, and even personal relationships.
In addition, as in the case of Taxotere, some doctors may not even know the full extent of the side effects of a cancer drug before they recommend it as a treatment option. Patients who are living with and fighting breast cancer have a right to clear, accurate, and complete information about their treatment options, presented in as objective a manner as possible so that they can make the choices that are best for themselves. Women know their personal preferences and ability to tolerate certain side effects and should be able to weigh these side effects against all the risks and rewards. Sanofi-Aventis, Inc., the manufacturer of Taxotere, had a legal obligation to disclose all possible common side effects of the drug, including permanent hair loss, and their alleged failure to do so is unconscionable.