Docetaxel (Taxotere®) and cisplatin chemotherapy
This information is about a chemotherapy treatment called docetaxel (Taxotere®) and cisplatin. It's most commonly used to treat lung cancer but may also be used for some other types of cancer.
The drugs that are used
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The treatment involves two chemotherapy drugs: docetaxel and cisplatin.
How treatment is given
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Your chemotherapy treatment will usually be given to you as a day patient, or occasionally you may need to stay in hospital overnight. 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 have tests to check how well your kidneys are working as the chemotherapy can affect them. These may include collecting your urine for 24 hours, or having a specific blood test known as an EDTA test. You will also be seen by a doctor, specialist nurse or pharmacist.
If the results of your tests are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.
Before you start the chemotherapy you'll be asked to take steroid tablets. This helps to prevent an allergic reaction to the docetaxel and can also help prevent sickness. It's very important to take these tablets and if for some reason you haven't taken them, you should let your doctor or nurse know before you start your chemotherapy.
When the chemotherapy drugs are ready the nurse will put 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 through a line, which is inserted under the skin into a vein near the collarbone (central line), or passed 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 anti-sickness (anti-emetic) drugs, usually by injection through the cannula, central line or PICC line. Some anti-sickness drugs can be given as tablets.
Docetaxel and cisplatin are both given to you as a drip (infusion). They are given separately. The docetaxel (a colourless fluid) will be given over an hour, but cisplatin (a colourless fluid) may be given over a longer period of time. You'll be given extra fluids before and after the cisplatin. These extra fluids are given to you as an infusion. As this can take several hours, it may be necessary to stay in hospital overnight.
When your treatment is finished you can usually go home. 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'll be given a supply of anti-sickness drugs to take home with you. It's important to take these regularly even if you aren't feeling sick because it is easier to prevent sickness than to stop it once it has started.
How often treatment is given
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Your doctor may use the word 'regimen' (eg the docetaxel and cisplatin regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular treatment that you are receiving.
After you have been given docetaxel and cisplatin as described, you will have a rest period with no chemotherapy for the next three weeks. This completes what is called a cycle of your treatment. Each cycle lasts for 21 days (three weeks).
After the rest period the same drugs will be given to you again. Usually, treatment cycles are given every three weeks. These can be repeated up to 4–6 times. You'll be assessed during treatment and your doctor or nurse will advise you how many cycles of treatment you will need.
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 is having treatment with docetaxel and cisplatin.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
Docetaxel and cisplatin 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 will 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 your white blood cells will then increase steadily and usually return 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. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
Bruising and bleeding
Docetaxel and cisplatin 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 can have a platelet transfusion if your platelet count is low.
Docetaxel and cisplatin 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.
Feeling sick (nausea) and being sick (vomiting)
This is common and may begin soon after the treatment is given and last for a few days. Occasionally it may last longer. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and 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.
Occasionally during treatment you may get a strange, metallic or bitter taste in your mouth. Some people find sucking on a strongly flavoured sweet or mint helps to disguise this. You may also notice that food tastes different but your normal taste will usually come back after treatment is over.
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 to reduce the risk of this happening. Some people may 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.
Docetaxel and cisplatin can cause diarrhoea. This can usually be easily controlled with medicine but tell your doctor if it is severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
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.
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.
A skin rash can sometimes occur while you are having treatment with docetaxel. It’s important to let your doctor know if this happens. Your doctor can prescribe medicine to help with this.
Sometimes areas of skin that have been treated with radiotherapy may become red and sore. Tell your doctor if this happens.
Numbness or tingling in hands or feet
This is due to the effect of docetaxel or cisplatin 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.
Changes in nails
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.
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.
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 taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate or machinery.
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.
Less common side effects
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Pain along the vein
Docetaxel can cause pain along the vein that is used to give you your chemotherapy. If you feel any pain, tell your doctor or nurse straight away so that they can check the infusion site. They may slow the infusion down to reduce pain.
Changes in hearing
Cisplatin may cause ringing in the ears (tinnitus) and you may lose the ability to hear some high-pitched sounds. Hearing loss can be more severe with higher doses and longer courses of treatment. Very occasionally, your sense of balance may be affected. Any hearing loss, and balance changes if they occur, may be permanent. However, tinnitus usually improves when treatment ends. Tell your doctor if you notice any loss of hearing or tinnitus.
Pain in the joints or muscles
This may be caused by docetaxel. It is important to tell your doctor about this, so they can prescribe painkillers to help.
Increased production of tears
This may be caused by docetaxel and is temporary. You may also notice that your eyes become sore and inflamed (conjunctivitis). Let your doctor know so they can prescribe soothing eye drops if necessary.
Your kidneys may be affected
Cisplatin can affect your kidneys. This doesn't usually cause any symptoms and the effect is generally mild. Rarely, it may cause permanent damage to the kidneys unless the treatment is stopped.
Before each treatment, your kidneys will be checked by a blood test. You’ll be given fluid through a drip (infusion) before and after the treatment to keep your kidneys working normally. You may be asked to measure and record what you drink and the amount of urine you pass. It’s important to tell your nurse or doctor if you pass less urine than usual.
If necessary, you may be given medicine to help you pass urine. You may be asked to drink extra fluid before and after treatment. It's important to do this so let your doctor know if this is a problem, for example, if you are feeling sick.
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.
Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
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 docetaxel and cisplatin as it may harm the developing baby. It's important to use effective contraception while taking these drugs, and for at least a few months afterwards. You can discuss this with your doctor or nurse.
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
Due to the effect of chemotherapy on the ovaries, women may find that their periods become irregular and they 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.
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 are 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.
This section is based upon our docetaxel and cisplatin 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.