What are the preparations for the first infusion of Docetaxel (docetaxel) for metastatic prostate cancer?

From the Guidelines

Preparation for the first docetaxel infusion for metastatic prostate cancer requires several important steps, including starting oral dexamethasone 8 mg, 12,3, and 1 hour before the infusion, as well as administering the standard docetaxel regimen of 75 mg/m² intravenously over 1 hour every 3 weeks, usually combined with daily oral prednisone 5 mg twice daily, as recommended by the most recent guidelines 1.

Key Considerations

• Prior to infusion, baseline blood work including complete blood count, liver function tests, and kidney function should be obtained to ensure the patient's safety and adjust the treatment plan as needed.
• Antiemetics such as ondansetron should be given 30 minutes before infusion to prevent nausea and vomiting.
• Patients should be well-hydrated and informed about potential side effects including neutropenia, fatigue, hair loss, peripheral neuropathy, nail changes, and diarrhea.
• Growth factor support, like filgrastim, may be considered for patients at high risk of febrile neutropenia, as indicated by recent studies 1.

Mechanism of Action and Interactions

• Docetaxel works by disrupting microtubule function, preventing cancer cell division and promoting apoptosis, making it effective against hormone-resistant prostate cancer cells.
• Patients should avoid alcohol and grapefruit products during treatment as they may interact with docetaxel metabolism, as noted in previous research 1.

Recent Guidelines and Recommendations

• The most recent guidelines from 2023 recommend the use of docetaxel in combination with ADT for patients with castration-sensitive prostate cancer and distant metastases, based on results from phase III trials such as CHAARTED and STAMPEDE 1.
• The standard docetaxel regimen is supported by evidence from multiple studies, including those published in the Journal of the National Comprehensive Cancer Network and the Annals of Oncology 1.

From the FDA Drug Label

For metastatic castration-resistant prostate cancer, the recommended dose of Docetaxel Injection is 75 mg/m2 every 3 weeks as a 1 hour intravenous infusion. Prednisone 5 mg orally twice daily is administered continuously [see Dosage and Administration (2.7)]. For metastatic castration-resistant prostate cancer, given the concurrent use of prednisone, the recommended premedication regimen is oral dexamethasone 8 mg at 12 hours, 3 hours, and 1 hour before the Docetaxel Injection infusion [see Warnings and Precautions (5.5)]. Docetaxel Injection requires NO prior dilution with a diluent and is ready to add to the infusion solution. Using only a 21 gauge needle, aseptically withdraw the required amount of Docetaxel Injection (20 mg docetaxel/mL) with a calibrated syringe and inject via a single injection (one shot) into a 250 mL infusion bag or bottle of either 0.9% Sodium Chloride solution or 5% Dextrose solution to produce a final concentration of 0.3 mg/mL to 0.74 mg/mL.

To prepare for the first infusion of Docetaxel for metastatic prostate cancer, the following steps should be taken:

• The recommended dose is 75 mg/m2 every 3 weeks as a 1 hour intravenous infusion.
• Prednisone 5 mg should be administered orally twice daily continuously.
• The recommended premedication regimen is oral dexamethasone 8 mg at 12 hours, 3 hours, and 1 hour before the Docetaxel Injection infusion.
• Docetaxel Injection should be prepared by aseptically withdrawing the required amount with a 21 gauge needle and injecting it into a 250 mL infusion bag or bottle of either 0.9% Sodium Chloride solution or 5% Dextrose solution.
• The final concentration should be between 0.3 mg/mL to 0.74 mg/mL.
• The Docetaxel Injection dilution for infusion should be administered intravenously as a 1-hour infusion under ambient room temperature and lighting conditions 2.

From the Research

Preparations for the First Infusion of Docetaxel

To prepare for the first infusion of Docetaxel for metastatic prostate cancer, consider the following:

• Dexamethasone Premedication: The administration of docetaxel requires the use of dexamethasone for the prevention of hypersensitivity reactions (HSRs) and fluid retention reactions (FRRs) 3.
• Dosage and Schedule: The dosage and schedule of docetaxel may vary, but common regimens include 75 mg/m2 every 21 days or 30 mg/m2 days 1,8,15,22, and 29 every 6 weeks, often in combination with prednisone 4.
• Patient Factors: Factors such as age, performance status, and primary tumor site may predict docetaxel-related toxicity 5.
• Combination Therapy: Docetaxel may be used in combination with other agents, such as estramustine and prednisolone, for the treatment of castration-resistant prostate cancer 6.
• Reducing Dexamethasone Dose: Recent studies suggest that the prophylactic dose of dexamethasone around docetaxel infusion can be safely reduced, which may help minimize side effects 7.

Key Considerations

• Hypersensitivity Reactions: HSRs can occur in approximately 7.8% of patients, and FRRs can occur in approximately 12.2% of patients 3.
• Toxicity: Common adverse events include anemia, neutropenia, infection, nausea, sensory neuropathy, fluid retention, alopecia, nail changes, diarrhea, and fatigue 4.
• Pretreatment Factors: Visceral metastasis and anemia have been identified as independent risk factors that can predict overall survival in patients with castration-resistant prostate cancer 6.