Upon diagnosis with stage 4 with Mets to his skeleton, in March 2018, my husband started Docetaxel. He finished 3 of the 6 treatments, was hospitalized twice, the last time requiring a 9 day ICU stay. He had experienced the capillary leak syndrome, ended up with PCP pneumonia and the doctor thankfully said we needed to stop chemo. Now just over 2 years later, he’s done Zytiga, Xofigo and currently on Xtandi. PSA rising (although with COVID-19, we’ve had to skip a month of labs — go Monday). At our last visit, doctor talked about having Cabazitaxel as an option. My husband is not sure he’s willing to go through chemo again, which leaves us few options if Xtandi is failing.
My question, I know the effects of medications differ on different patients, but trying to get a sense of how the 2 chemo drugs compare as far as side effects. I’ve been told cabazitaxel is not as bad as Docetaxel, but I’m curious for those who’ve had both what would you share? Thank you in advance! - Cindy
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WVtwinsmama
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I was just at the doctor today .... I also was in terrible shape with Docetaxel. If I have to go back on ... it will be cabazitaxel as well. Doc said it was easier on the body ....
Quite a few people have said Cabazitaxel is easier than Docetaxel. I've had Docetaxel and didn't think is was that bad although I was really tired of it after 6 rounds.
Cabazitaxel will also be my next treatment after Zytiga stops being effective. I'm hoping it will be easier, but then you only have to commit to one cycle anyway. Anyone who does chemotherapy can quit at any time if the side effects are not worth it. The side effects go away fairly quickly.
Hi, I have had 10 cycles of Docetaxel and the side effects were not too severe. Taste was affected for 4/5 days and stomach issues were controlled with OTC meds. Now I have just had my second cycle of Cabazitaxel and I feel it is a much milder form of chemo. All side effects are reduced by at least 50%. It is early days yet but my opinion is that Cabszitaxel is a treatment that your husband may tolerate better.
My doctor was telling me that they had to lower the dose with Cabazitaxel because of myelosuppression. The dose for Cabazitaxel is 25mg/m2 vs. 75mg/m2 for Docetaxel. I know they are different chemotherapies, but I'm wondering if that's why the side effects are more tolerable for most.
I'm no kind of expert on chemotherapy and have not had any chemo treatment myself, so what I have to say below is based only on my interpretation of what I've read from others and from a few articles from Pubmed. If you like the ideas, you'll need to hear from others here and, of course, to consult with your husband's oncologist.
A number of patients have said that they have been treated with lower doses of docetaxel than the standard 75 mg/m^2 given every 3 weeks. Many have gotten the standard dose, but spread out differently - 50 mg/m^2 every 2 weeks, or 25 mg/m^2 every week. Perhaps others have gotten lower doses less frequently, either getting a lower than standard total dose, or getting the standard amount of docetaxel, but over a prolonged period. The reports I've seen from patients and some articles in Pubmed show good effectiveness and lower, sometimes much lower, levels of adverse effects with the standard dose given in smaller increments.
Looking at the FDA label for Jevtana (a heavily used brand of cabazitaxel), I see that the scientists are recommending that the standard dose be cut in half if there are dangerous side effects.
Your husband has experience with docetaxel. He knows it's dangerous for him. But if it has helped him a lot, maybe it's worth trying again at the lowest possible dose. It's possible that Jevtana will also be hard for him to take but might also be helpful, even at the lowest possible dose.
So here's what I recommend:
Talk to the oncologist about starting whatever chemo treatment you believe is most likely to be effective, but starting with a very low dose. Only increase it if it is showing some benefit and if the adverse effects are manageable. And if increasing the dose, then only increase it gradually, in small steps. If the response to the increase is about the same as the response to the lower dose, maybe any additional increase isn't necessary. Maybe the drug is doing whatever it can do at the lower dose.
I'll repeat that I don't have any expertise in any of this, but it seems logical to me, it's consistent with what I've read, and I think it's worth discussing with the oncologist. If the oncologist says I'm wrong, well, he (hopefully) knows a lot more than I do and his opinion is worth more than mine. However I know for a fact that there are reputable oncologists who will try lower doses of chemotherapy so it may be worth consulting another onc if the first one rejects the ideas out of hand.
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