Chemotherapy side effects

May 20, 2008.

Taxotere ®

Generic Name: Docetaxel
Link to Scientific American Article from 1996, discussing Taxoids (this is a PDF file).

Drug Type:

Taxotere is an anti-cancer (“antineoplastic” or “cytotoxic”) chemotherapy drug. Taxotere is classified as a “plant alkaloid,” a “taxane” and an “antimicrotubule agent.” (For more detail, see “How Taxotere Works” section below).

Taxotere Side Effects:

Important things to remember about Taxotere side effects:

• Most people do not experience all of the Taxotere side effects listed
• Taxotere side effects are often predictable in terms of their onset and duration
• Taxotere side effects are almost always reversible and will go away after treatment is complete
• There are many options to help minimize or prevent Taxotere side effects
• There is no relationship between the presence or severity of Taxotere side effects and the effectiveness of Taxotere.
• Taxotere side effects and their severity depend on how much Taxotere is given. In other words, high doses of Taxotere may produce more severe side effects).

The following Taxotere side effects are common (occurring in greater than 30%) for patients taking Taxotere:

• Low white blood cell count (this can increase your risk for infection)
• Low red blood cell count (anemia)

Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts.

Onset: 4-7 days
Nadir: 5-9 days
Recovery: 21 days

• Fluid retention with weight gain, swelling of the ankles or abdominal area.
• Peripheral neuropathy (numbness in your fingers and toes) may occur with repeated doses. This should be reported to your healthcare provider.
• Nausea
• Diarrhea
• Mouth sores
• Hair loss
• Fatigue and weakness
• Infection
• Nail changes (color changes to your fingernails or toenails may occur while taking Taxotere. In extreme, but rare, cases nails may fall off. After you have finished Taxotere treatments, your nails will generally grow back.)

These Taxotere side effects are less common, meaning they occur in 10-29 percent of patients receiving Taxotere:

• Vomiting
• Muscle/bone/joint pain (myalgias and arthralgias)
• Low platelet count (This can increase your risk of bleeding)
• Increases in blood tests measuring liver function. These return to normal once treatment is discontinued. (see liver problems)

Infusion-related Taxotere side effects (symptoms which may occur during the actual treatment) include:

• Allergic reactions (rash, flushing, fever, lowered blood pressure). Happens rarely, usually occurs in the first or second infusion. Frequency is reduced by premedication with corticosteroid starting one day before infusion. You will be monitored closely during the infusion for any signs of allergic reaction.
• Infusion site reactions (uncommon and generally mild, consist of darkening of the vein, inflammation, redness or dryness of the skin, or swelling of the vein).

Not all Taxotere side effects are listed above, some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When To Contact Your Doctor or Health Care Provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

• Fever of 100.5º F (38º C) or higher, chills (possible signs of infection)

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

• Nausea (interferes with ability to eat and unrelieved with prescribed medication).
• Vomiting (vomiting more than 4-5 times in a 24 hour period).
• Diarrhea (4-6 episodes in a 24-hour period).
• Unusual bleeding or bruising.
• Black or tarry stools, or blood in your stools or urine.
• Extreme fatigue (unable to carry on self-care activities).
• Mouth sores (painful redness, swelling or ulcers).
• Yellowing of the skin or eyes.
• Swelling of the ankles. Weight gain. Swelling of the stomach.
• Shortness of breath.

Always inform your health care provider if you experience any unusual symptoms.

Taxotere Precautions:

• Before starting Taxotere treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
• Do not receive any kind of immunization or vaccination without your doctor’s approval while taking Taxotere.
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (Taxotere may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
• For both men and women: Do not conceive a child (get pregnant) while taking Taxotere. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
• Do not breast feed while taking Taxotere.

Taxotere Self Care Tips:

• You may be at risk of infection so try to avoid crowds or people with colds or not feeling well, and report fever or any other signs of infection immediately to your health care provider.
• Wash your hands often.
• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
• Use an electric razor and a soft toothbrush to minimize bleeding.
• Avoid contact sports or activities that could cause injury.
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
• Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing. Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
• Get plenty of rest.
• Maintain good nutrition.
• If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing While Taking Taxotere:

You will be checked regularly by your health care professional while you are taking Taxotere, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.

How Taxotere Works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. “Normal” cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The “normal” cells will grow back and be healthy but in the meantime, side effects occur. The “normal” cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body.

Taxotere belongs to a class of chemotherapy drugs called plant alkaloids. Plant alkaloids are made from plants. The vinca alkaloids are made from the periwinkle plant (catharanthus rosea). The taxanes are made from the bark of the Pacific Yew tree (taxus). The vinca alkaloids and taxanes are also known as antimicrotubule agents. The podophyllotoxins are derived from the May apple plant. Camptothecan analogs are derived from the Asian “Happy Tree” (Camptotheca acuminata). Podophyllotoxins and camptothecan analogs are also known as topoisomerase inhibitors. The plant alkaloids are cell-cycle specific. This means they attack the cells during various phases of division.

• Vinca alkaloids: Vincristine, Vinblastine and Vinorelbine
• Taxanes: Paclitaxel and Taxotere
• Podophyllotoxins: Etoposide and Tenisopide
• Camptothecan analogs: Irinotecan and Topotecan

Antimicrotubule agents (such as Taxotere), inhibit the microtubule structures within the cell. Microtubules are part of the cell’s apparatus for dividing and replicating itself. Inhibition of these structures ultimately results in cell death.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

April 22, 2008.

Taxol/Paclitaxel

Now that I am officially done with my A/C treatment, Let’s take a look at Taxol. I’ll be beginning treatment with this chemo drug on May 6.

A good, reliable source of info on chemo drugs is Medline Plus.

To read the story of Taxol’s origins and discovery, check out this article from Florida State University. This chemo drug was created based on a cancer-fighting substance found in the bark of the Pacific Yew tree, Taxus brevifolia.

Side effects

The following is from Medline Plus.

The most common side effect of paclitaxel is a decrease of blood cells. Your doctor may order tests before, during, and after your treatment to see if your blood cells are affected by the drug.

Side effects from paclitaxel are common, and include:

• nausea and vomiting
• loss of appetite
• change in taste
• thinned or brittle hair
• pain in the joints of the arms or legs lasting 2-3 days
• changes in the color of the nails
• tingling in the hands or toes

Tell your doctor if either of these symptoms is severe or lasts for several hours:

• mouth blistering
• fatigue

If you experience any of the following symptoms, call your doctor immediately:

• unusual bruising or bleeding
• pain, redness, or swelling at the injection site
• change in normal bowel habits for more than 2 days
• fever
• chills
• cough
• sore throat
• difficulty swallowing
• dizziness
• shortness of breath
• severe exhaustion
• skin rash
• facial flushing
• chest pain

Taxol IV Interactions

Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: other drugs that may decrease bone marrow function (e.g., azathioprine, trimethoprim/sulfamethoxazole), drugs affecting liver enzymes that remove paclitaxel from your body (such as azole antifungals including ketoconazole, macrolide antibiotics including erythromycin, rifamycins including rifabutin, St. John’s wort, certain anti-seizure medicines including phenytoin).

Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as: certain antihistamines (e.g., diphenhydramine), anti-seizure drugs (e.g., carbamazepine), medicine for sleep or anxiety (e.g., alprazolam, diazepam, zolpidem), muscle relaxants, narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., chlorpromazine, risperidone, amitriptyline, trazodone).

Check the labels on all your medicines (e.g., cough-and-cold products) because they may contain ingredients that may cause drowsiness. Ask your pharmacist about using those products safely.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

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Adriamycin

It’s pretty clear to me that I am very sensitive to chemicals and pharmaceuticals. I have allergic reactions to damned near everything I try to take. Reactions tend to be mild at first, and become increasingly bad with each exposure.

I’m on adriamycin and cytoxan this round (3/11, 3/25, 4/8, 4/22), and taxol the next round ( 5/6, 5/20, 6/3, 6/17).

The generic name for adriamycin is doxorubicin.

The FDA label states the following:

WARNINGS: Special attention must be given to the cardiotoxicity induced by doxorubicin. Irreversible myocardial toxicity, manifested in its most severe form by life-threatening or fatal congestive heart failure, may occur either during therapy or months to years after termination of therapy.

From MedlinePlus:

Doxorubicin can cause a decrease in the number of blood cells in your bone marrow. Prolonged use of doxorubicin can also cause severe heart damage, even years after you have stopped taking doxorubicin. The risk of heart damage after stopping doxorubicin is higher in children.

Tell your doctor if you have ever had chemotherapy with daunorubicin (Cerubidine, DaunoXome), doxorubicin, idarubicin (Idamycin), or radiation therapy to the chest and if you have or have had heart or liver disease. Tell your doctor if you are taking cyclophosphamide (Cytoxan, Neosar) or mitoxantrone (Novantrone).

If you experience any of the following symptoms, call your doctor immediately: back pain, flushing, or chest tightness. Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to doxorubicin.

When doxorubicin is administered into a vein, it may leak into surrounding tissue. Your doctor or health care provider will monitor your administration site for this reaction.

Side effects from doxorubicin are common and include:

• nausea and vomiting which may last up to 24-48 hours after treatment
• loss of appetite
• diarrhea
• difficulty swallowing
• thinned or brittle hair
• skin irritation (sunburn-like) or rash on areas previously exposed to radiation treatments
• darkening of fingernails or toenails
• swelling, pain, redness, or peeling of skin on the palms and soles of the feet

Tell your doctor if either of these symptoms is severe or lasts for several hours:

• fatigue
• mouth blistering

If you experience any of the following symptoms or those listed in the IMPORTANT WARNINGS section, call your doctor immediately:

• unusual bruising or bleeding
• red urine or sweat
• pain at the injection site
• persistent diarrhea or any change in normal bowel habits for more than 2 days
• fever
• chills
• sore throat
• breathing discomfort

The generic name for Cytoxan is Cyclophosphamide

Side effects from cyclophosphamide are common and include:

• thinned or brittle hair
• darkened and thickened skin
• blistering skin or acne
• loss of appetite or weight

Tell your doctor if either of these symptoms is severe or lasts for several hours:

• mouth blistering
• fatigue

If you experience any of the following symptoms, call your doctor immediately:

• painful urination or red urine
• black, tarry stools
• unusual bruising or bleeding
• cough
• congestion
• fever
• dizziness
• chills
• shortness of breath
• sore throat
• swelling of the feet or ankles
• nausea and vomiting
• rash

My symptoms after taking A/C last Tuesday

I had these symptoms beginning Wednesday, March 12.

• diarrhea (intermittent)
• congestion
• dizziness
• shortness of breath
• cold sweats (especially at night)
• facial swelling
• leg cramps (Started Sunday, got rid of them Thursday)
• fatigue
• chest tightness (last week Thursday and Friday)
• sore throat and laryngitis (this I still have, but it’s not as bad today)
• difficulty swallowing (Since Thursday March 20th)
• weakness
• changes in menstrual cycle
• loss of appetite

I reported them to my doctor on Friday, and she decided that they weren’t bad enough to change or discontinue treatment, so I should take 1-2 Benadryl every four hours while I’m awake for the next couple of days.

Benadryl puts me to sleep. Imagine trying to lead as normal a life as possible while undergoing chemo — except that now, add to the list of symptoms: you are walking around in your sleep.

I am a bit concerned about my possible allergic reactions next week, especially if this past week’s reaction was “mild.”

I’ll keep you posted.