Capecitabine and docetaxel chemotherapy
This information is about a chemotherapy treatment for breast cancer called capecitabine and docetaxel.
The drugs that are used
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The treatment involves two chemotherapy drugs: capecitabine and docetaxel, which is also called Taxotere®.
How treatment is given
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Your chemotherapy treatment is usually given to you as a day patient. Before you start treatment you'll need to have a blood test, either on the same day or a few days beforehand. You'll 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. This may take a couple of hours.
The nurse will insert a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful, but it shouldn't take long. Some people have their chemotherapy given through a thin, plastic tube inserted under the skin and into a vein near the collarbone (central line) or through a vein in the crook of their arm (PICC line). Your doctor or nurse will explain more about this to you.
You'll be given some anti-sickness (anti-emetic) drugs. These are usually injected through the cannula, which is connected to a drip, but some anti-sickness drugs can also be taken as tablets.
You'll 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's important to take the steroid tablets as prescribed.
The drugs are then given separately, starting with a drip (infusion) of docetaxel (a colourless fluid) that lasts for about an hour. You'll then be given capecitabine tablets to take home.
Capecitabine is usually given as a combination of 500mg and 150mg peach-coloured tablets. You need to make sure you're taking the right dose.
You should swallow the tablets whole with a glass of water. They should be taken within half an hour of finishing a meal, as capecitabine works best if it's broken down in the stomach with food. You should take them in the morning just after breakfast and then again just after your evening meal so that the doses are spaced at least eight hours apart.
If you have trouble swallowing the capecitabine tablets, you can dissolve them in a 200ml glass of warm water. Stir the mixture with a spoon until the tablets are completely dissolved and drink it immediately. Wash the glass and spoon, and keep them separate from your other crockery and cooking utensils.
If you're being treated as a day patient, you can go home when it has finished. 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'll be shown how to look after the line.
You'll be given a supply of anti-sickness tablets to take home with you. It's important to take these as directed even if you aren't feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than stopping it once it starts.
How often treatment is given
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Your doctor may use the word 'regimen' (eg capecitabine/docetaxel regimen) when talking about your chemotherapy. This refers to the whole plan or schedule of your particular chemotherapy treatment.
On the first day of treatment you'll be given an infusion of docetaxel. On the same day you'll also start your capecitabine tablets, which you'll take twice daily for two weeks. When you finish your capecitabine tablets, you'll have a rest period with no chemotherapy for the next week. This completes what is called a cycle of your chemotherapy.
You'll start the next cycle of your treatment after the rest period, which will be three weeks after your first infusion. 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 here won't affect everyone who has capecitabine and docetaxel chemotherapy.
We have outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Capecitabine and docetaxel chemotherapy can cause diarrhoea. This can be quite severe but can usually be controlled with medicines. It's important to drink plenty of fluids, and you may be given medicine to take. Follow the instructions and take it immediately.
If you have diarrhoea more than 4−6 times a day, or if you have it at night, contact your specialist immediately for advice. You may be advised to stop taking capecitabine. However, once the diarrhoea has eased your doctor will tell you if you can restart the treatment, perhaps at a lower dose.
Risk of infection
Capecitabine and docetaxel chemotherapy can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you'll be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia can begin 5–7 days after treatment, and your resistance to infection usually reaches its lowest point 7–10 days after chemotherapy. The number of white blood cells in your blood then increases steadily and usually returns to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel unwell even with a normal temperature.
You'll have a blood test before having more chemotherapy to check the number of white blood cells in your blood. Occasionally, your treatment might need to be delayed if the number of your blood cells (blood count) is still low.
Bruising or bleeding
The chemotherapy can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You may need to have a platelet transfusion if your platelet count is low.
Capecitabine and docetaxel chemotherapy can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Your mouth may become sore or dry, 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 reduce the risk of this happening. Some people find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Some people can have an allergic reaction to docetaxel while it’s being given. Signs of this can include skin rashes and itching, a high temperature, shivering, dizziness, a headache and breathlessness.
Usually you'll be given steroid tablets to take at home the day before treatment to reduce the chance of this happening. It’s important to take the steroid tablets as you have been directed.
Instead of steroid tablets, you may be given a steroid by injection into a vein (intravenously) 30–60 minutes before the docetaxel. Other drugs, such as antihistamines, may also be injected into a vein before your treatment to prevent an allergic reaction.
You'll be closely monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these symptoms. If you do have a reaction, it can be treated quickly.
Treatment can cause a rash or dry skin, which may be itchy. Your doctor can prescribe medicine to help with this.
Soreness and redness of the palms of the hands and soles of the feet
This is known as palmar plantar or hand-foot syndrome. It's temporary and improves when the treatment finishes. If you get hand-foot syndrome, contact your specialist doctor or nurse for advice.
Your doctor may prescribe creams or a vitamin called pyridoxine (vitamin B6), which some people find helpful. It can also help to keep your hands and feet cool and to avoid tight-fitting clothing, such as socks, shoes and gloves.
During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than normal. You can still go out in the sun but should wear a suncream with a high sun protection factor (SPF) and cover up with clothing and a hat.
Feeling sick (nausea) or being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea or vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
This usually starts 2–3 weeks after the first dose of docetaxel, although it may occur earlier. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is usually temporary, and your hair will almost always start to grow again once the treatment has finished. Your hair may grow back straighter, curlier, finer or a slightly different colour than it was before treatment. 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's available at your hospital.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Abdominal pain and constipation
Capecitabine and docetaxel chemotherapy can cause pain in your tummy (abdomen) and constipation. Let your doctor know if you develop pain. It can usually be controlled with mild painkillers.
can usually be helped by drinking plenty of fluids, eating more fibre and doing some exercise. You may need to take medicine (laxatives) to help. Your doctor can prescribe these or you can buy them at a pharmacy.
Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
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'll be given steroid tablets (usually dexamethasone) to take for three days, beginning the day before treatment.
Less common side effects
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Some people find that capecitabine causes headaches. Let your doctor or nurse know. They can give you painkillers to relieve this.
Increased production of tears
This may be caused by capecitabine and is temporary.
Numbness or tingling in the hands or feet
This is due to the effect of docetaxel on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks.
Tell your doctor if you notice any numbness or tingling in your hands or feet. It's important to report your symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug.
This side effect usually improves slowly, a few months after the treatment has finished. Sometimes symptoms can persist; talk to your doctor if this happens.
Pain in joints or muscles
This may be caused by docetaxel. It's important to tell your doctor about this so they can prescribe painkillers to help.
The colour of your nails may change. They may become darker and white lines may appear on them. These usually grow out over several months once the treatment has finished. Some people have pain in the nail bed at the base of the nail but this is rare.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and 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’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Capecitabine interacts with the drugs phenytoin (Epanutin®), allopurinol (Zyloric®) and interferon alpha (IntronA®, Roferon-A®). It may also affect the action of some medicines given to thin the blood (anti-coagulants), such as warfarin. Let your doctor know if you are taking any of these.
You should also tell your doctor if you’re taking folic acid because it might increase the side effects of capecitabine.
Some other medicines, including those you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Leakage into the tissue around the vein (extravasation)
If this happens when docetaxel is being given, the tissue in that area can become damaged. Tell the doctor or nurse immediately if you notice any stinging or burning around the vein while the drug is being given. This is unlikely to happen if the chemotherapy is given through a central or PICC line.
If the area around the injection site becomes red or swollen at any time, you should tell the doctor or nurse on the ward. If you're at home, ring the clinic or ward and ask to speak to the doctor or nurse.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having capecitabine and docetaxel, as it may harm the developing baby. It’s important to use effective contraception while having this chemotherapy and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
Loss of periods in women
Because of the effect of chemotherapy on the ovaries, women may find that their periods become irregular and may eventually stop. In some women this may be temporary, but for others it will be permanent. This will result in menopausal symptoms, such as hot flushes, sweats and vaginal dryness.
There's a potential risk that chemotherapy drugs may be present in breast milk. Women are advised not to breastfeed during chemotherapy and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you're having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
Things to remember about capecitabine tablets
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Swallow your tablets whole with a glass of water.
It’s important to take your tablets at the right times as directed by your doctor.
Always tell any doctors treating you for non-cancerous conditions that you're taking a course of chemotherapy tablets that should not be stopped or restarted without advice from your cancer specialist.
Keep the tablets in their original packaging, and store them at room temperature away from heat and direct sunlight.
Keep the tablets in a safe place and out of the reach of children.
If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Don't flush them down the toilet or throw them away.
If you're sick just after taking the tablets tell your doctor as you may need to take another dose. Don't take another tablet without telling your doctor first.
If you forget to take a tablet, don't take a double dose. Let your doctor know and keep to your regular dose schedule.
This section is based upon our capecitabine and docetaxel chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). (accessed October 2011).
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.