Docetaxel — Drug Monograph

Brand names: Taxotere

Drug class: Taxane

Mechanism of Action

Semisynthetic taxane derived from the European yew tree (Taxus baccata). Binds β-tubulin with higher affinity than paclitaxel, stabilizing microtubules and preventing depolymerization. More potent than paclitaxel on a molar basis. M-phase specific.

FDA Indications

• Locally advanced or metastatic breast cancer — anthracycline failure or in combination (AC-T)
• NSCLC — locally advanced or metastatic, first-line with cisplatin; second-line monotherapy
• Hormone-refractory metastatic prostate cancer — in combination with prednisone (TAX327)
• Gastric adenocarcinoma — first-line with cisplatin and 5-FU (DCF)
• Squamous cell carcinoma of head and neck — induction with cisplatin and 5-FU (TPF regimen)

Common Side Effects

• Myelosuppression (nadir day 7–8)
• Alopecia (universal, reversible)
• Fluid retention (edema, pleural/pericardial effusions, weight gain — cumulative)
• Peripheral neuropathy
• Nail changes (onycholysis, nail loss)
• Fatigue
• Mucositis
• Skin/nail hyperpigmentation

Clinical Pearl

Cumulative fluid retention (edema, weight gain, effusions) is characteristic of docetaxel and progresses with increasing cycles. Dexamethasone premedication dramatically reduces this syndrome. The cold cap approach for scalp cooling may be less effective for docetaxel than paclitaxel. Nail changes (onycholysis) can be reduced by wearing cold gloves during infusion.

Related Therapies & Mechanisms

• Paclitaxel (Taxol) — Taxane · Breast
• Pembrolizumab (Keytruda) — NSCLC
• Nab-paclitaxel (Paclitaxel Protein-Bound) (Abraxane) — Taxane · Breast
• 5-Fluorouracil (5-FU) (Adrucil) — Breast