The cytostatic Docetaxel belongs to the group of taxanes. It is used to treat various types of cancer.
What is Docetaxel?
Docetaxel is a cytostatic that comes from the group of active substances called taxanes. The drug is produced by the French pharmaceutical company Sanofi.
Docetaxel is a structural derivative of the cytostatic agent paclitaxel. The drug is produced semi-synthetically from precursors contained in the European yew tree (Taxus baccata).
While the first taxane paclitaxel was obtained from the Pacific yew or its bark, docetaxel succeeded in isolating the substance 10-deacetyl-baccatin III from the European yew. The formation of docetaxel follows after the esterification. The advantage is that the European yew is available more quickly than the very slow-growing Pacific yew.
Docetaxel was approved in Europe in the 1990s. As an infusion preparation it is on the market in Germany under the trade name Taxere®.
Pharmacological effect
Docetaxel works by inhibiting tumor growth. Before a cancer cell divides and multiplies, the cell nucleus must split and both halves must be pulled apart. For this purpose, the cell produces small protein threads called microtubules. The threads have the property of being attached to the inner wall of the cell. The same applies to the half of the cell nucleus that points inwards. The cell nucleus halves are pulled apart by shortening the protein threads. In this way, the cell walls of the daughter cells can arise in the space in between.
Docetaxel unfolds its positive effect by intervening in the process of cell division. Its influence leads to an excessive formation of microtubules, which in turn slows down their breakdown for reuse purposes. As a result, the cell no longer receives sufficient threads that serve as building material for cell division. In the further course, the cells stop multiplying. This process has a more negative effect on the cancer cells than on the healthy cells of the body, since they divide more quickly.
Docetaxel also has the property of not only inhibiting cancer cells, but also killing them. The reason for this is that the microtubules are also important for the transport of important substances during cell division. Docetaxel is metabolized in the liver.
Medical application & use
Docetaxel is used to treat various types of cancer. It can be administered as a single preparation or combined with other cytostatics. This happens, for example, in the treatment of breast cancer, in which the patient receives not only docetaxel but also cyclophosphamide and doxorubicin. This is especially the case when the cancer originates in lumps that can be operated on. Together with doxorubicin, docetaxel is also used to treat breast cancer with metastasis. However, in this case no other chemotherapy must have taken place beforehand.
Docetaxel is only used as a monopreparation if the tumor has progressed locally or if daughter tumors have formed. In addition, if chemotherapy with alkylating cytostatics or anthracyclines was unsuccessful. Docetaxel is occasionally given together with capecitabine in such cases.
Another indication is lung cancer. The cytostatic agent is used individually for locally advancing non-small cell lung cancers or the formation of metastases. If this form of cancer cannot be treated surgically, it is often combined with cisplatin.
In the context of prostate cancer, treatment with docetaxel takes place if hormone therapy is unsuccessful and metastases have developed. The cytostatic agent is used together with prednisolone or prednisone.
In gastric adenocarcinoma, docetaxel is part of a combination treatment with 5-fluorouracil and cisplatin. This treatment takes place in the presence of daughter tumors, provided that no chemotherapy has been carried out beforehand.
Another area of application for docetaxel is cancer of the head and neck region. Squamous cell carcinomas are treated.
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As a result of treatment with docetaxel, patients almost always suffer from side effects. These primarily include neuropathies and moderate neutropenias, in which there is a decrease in neutrophil granulocytes. However, dangerous febrile neutropenia associated with fever is rare. The blood formation disorders show up in up to 95 percent of all patients, but can be alleviated with appropriate medication.
Other common unwanted side effects are fever, taste disorders, sensory disturbances in the limbs, inflammation of the oral mucosa, breathing problems, movement control disorders, hair loss, diarrhea, nausea, vomiting, muscle pain, changes in the nails, skin reactions, infections such as pneumonia or a Blood poisoning, fluid retention, pain, feelings of weakness and loss of appetite.
Abdominal pain, constipation, low blood pressure, a lack of blood platelets, an increase in blood bilirubin, joint pain and chest pain can also occur. Occasionally, patients also have inflammation of the esophagus. In the worst case, even heart failure is possible.
The extent of the side effects also depends on the dose of docetaxel administered and the use of other cytostatics.
If there is hypersensitivity to docetaxel, the administration of the chemotherapeutic agent must be avoided. The same applies to severe liver dysfunction and an abnormal blood count. In the case of a water belly (ascites), consistent monitoring by the doctor is required.
Docetaxel must not be administered during pregnancy and breastfeeding. In the event of therapy, consistent contraceptive measures are recommended.
