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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more| .
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This information is about a chemotherapy| treatment for breast cancer| called capecitabine and docetaxel. It describes the drugs used, how they are given and some of the possible side effects. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer information nurse specialists|.
The treatment involves the two chemotherapy drugs: capecitabine| and docetaxel|, which is commonly called Taxotere®.
Capecitabine is available as 500mg peach coloured tablets and 150mg light-peach coloured tablets. Taxotere is a colourless fluid.
Your chemotherapy treatment is usually given to you as a day patient. You will need to have a blood test before you start treatment - either on the same day, or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.
The nurse will then put a thin tube (cannula) into a vein in your arm or hand. You may find this uncomfortable or a little painful but it should not take long. Some people have their chemotherapy given through a thin plastic tube that is inserted under the skin into a vein near the collarbone (central line|) or through a vein in their arm (PICC line|).
You will be given some anti-sickness (anti-emetic) drugs. These are usually given by injection through the cannula, which is connected to a drip, but some anti-sickness| drugs can also be taken as tablets.
You will usually be given a short course of steroid tablets to start taking the day before your chemotherapy. These are given to reduce the chance of an allergic reaction and to help reduce other side effects, such as fluid retention. It is important to take the steroid tablets as prescribed.
The drugs are then given separately, starting with:
If you are having your treatment as a day patient you can go home when it is finished and the cannula will be removed before you go. If you have a central or PICC line it will usually stay in place, ready for the next cycle of your chemotherapy. You will be shown how to look after the line.
You will be given a supply of antisickness tablets to take home with you. It is important to take these as directed, even if you aren't feeling sick – as some anti-sickness drugs are much better at preventing sickness than stopping it once it has started.
You doctor may use the word 'regimen' (eg capecitabine/docetaxel regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular chemotherapy treatment that you are receiving.
On the first day of treatment you will start your capecitabine tablets, which you will take twice daily for two weeks. On the same day you will also be given a drip (infusion) of Taxotere. When you finish your capecitabine tablets you will have a rest period with no chemotherapy for the next week. This completes what is called a cycle of your chemotherapy.
You will start the next cycle of your treatment after the rest period, which will be three weeks after your first injection. This treatment is usually given for 4–6 cycles over a period of 3–4 months. This makes up a course of treatment.
Each person's reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described below will not affect everyone who is having capecitabine/docetaxel chemotherapy.
We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you do notice any effects which you think may be due to the drug but which are not listed here, please let your nurse or doctor know.
Diarrhoea This can be quite severe but can usually be controlled with medicines. If you have diarrhoea more than 4–6 times a day, contact your specialist immediately. You may be advised to stop taking capecitabine. It is often possible, however, to restart the treatment at a lower dose. It is important to drink plenty of fluids if you have diarrhoea|.
Lowered resistance to infection The chemotherapy can reduce the production of white blood cells by the bone marrow, making you more prone to infection|. This effect can begin seven days after treatment has been given, with your resistance to infection usually reaching its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.
Bruising or bleeding The chemotherapy can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.
Anaemia (low number of red blood cells) While having treatment with capecitabine/docetaxel you may become anaemic. This may make you feel tired| and breathless|. Let your doctor or nurse know if this is a problem.
Sore mouth and ulcers Your mouth may become sore|, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can give you special mouthwashes and medicines to prevent or clear any mouth infection.
Taste changes You may also notice that your food tastes different. Normal taste will usually come back after the treatment finishes.
Allergic reaction Signs of an allergic reaction include rashes and itching, a high temperature, shivering, redness of the face, a feeling of dizziness, headache, breathlessness, anxiety and a need to pass urine. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these symptoms.
Soreness and redness or darkening of the palms of the hands and soles of the feet This is sometimes known as palmar plantar syndrome or hand foot syndrome. You may be prescribed vitamin B6 (pyridoxine), which can help to reduce this. A rash, and dry or itchy skin, may also occur. If you notice this, let your doctor or nurse know.
Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting|. If the sickness is not controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness drugs that may be more effective. Some anti-sickness medicines cause drowsiness. If you feel drowsy or unwell, do not operate machinery or drive. Other anti-sickness drugs may cause constipation. Let your doctor or nurse know if this is a problem.
Hair loss This usually starts 2–3 weeks after the first course of treatment (and is due to the docetaxel). Hair is usually lost completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss| is temporary and your hair will start to grow again once the treatment has finished. Your nurse can give you advice about coping with hair loss.
Scalp cooling| is a method of reducing hair loss that may be helpful for some people. You can ask your doctor or nurse if it is available at your hospital.
Tiredness Many people feel extremely tired (fatigued)| during chemotherapy. This is a very common side effect and it is important to try to get as much rest as you need.
Abdominal pain and constipation It may help to drink plenty of fluids, eat a high-fibre diet and take gentle exercise. Sometimes you may need to take medicines to stimulate your bowel. These can be prescribed by your doctor or bought from a pharmacy.
Loss of appetite A dietitian or specialist nurse at your hospital can give advice on boosting your appetite, coping with eating difficulties| and maintaining weight.
Fluid retention You may notice that you gain weight and/or that your ankles and legs swell. This decreases slowly once your treatment has finished. To help reduce the chance of fluid retention you will be given steroid| tablets (usually dexamethasone) to take for three days beginning the day before treatment.
Headaches and dizziness Tell your doctor if you have headaches or feel dizzy and lightheaded while taking capecitabine.
Increased production of tears This may be caused by capecitabine and is temporary.
Numbness or tingling of the hands or feet This is due to the effect of docetaxel on the nerves and is known as peripheral neuropathy|. You may also notice that you have difficulty with doing up buttons or other fiddly tasks. Tell your doctor if you notice any numbness or tingling of your hands or feet. This usually improves slowly a few months after the treatment.
Pain in joints or muscles This may be caused by docetaxel. It is important to tell your doctor about this, so that appropriate painkillers can be prescribed.
Changes in nails The colour of your nails may change. This change grows out over several months once the treatment has finished. Pain in the nail bed (at the base of the nail) may occur, but this is rare.
Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it is important to tell your doctor straight away if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs to thin the blood. Your doctor or nurse can give you more information.
Other medicines Some other medicines can be harmful to take when you are having chemotherapy (including those you can buy in a shop or chemist).
Capecitabine is known to react with the drugs phenytoin (Epanutin®), allopurinol (Zyloric®) and interferon| (IntronA®, Roferon-A®). It may also affect the action of some medicines given to thin the blood (anti-coagulants), such as warfarin. You should let your doctor know if you are taking any of these.
It's a good idea to tell your doctor about other medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Let your doctor know if you are taking folic acid because it might increase the side effects of capecitabine.
Leakage into the tissue around the vein If you notice any stinging or burning around the vein while the drug is being given, or any leakage of fluid from the cannula site, it is very important that you tell the doctor or nurse immediately. If the area around the injection site becomes red or swollen at any time, let your doctor or nurse know.
Fertility Your ability to become pregnant or father a child may be affected by this treatment. It's important to discuss fertility| with your doctor before starting treatment.
Contraception It's not advisable to become pregnant or father a child while having capecitabine and docetaxel as these drugs may harm the developing foetus. It is important to use effective contraception whilst having the treatment and for at least a few months afterwards. Again, discuss this with your doctor.
This section is based upon our capecitabine and docetaxel chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:
For further references, please see general bibliography|.
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