Docetaxel Chemo: What Helped Me…

[AlvinSD]

I am on triplet therapy (ADT, darolutamide and Docetaxel) and will be continuing on to radiation in December I wanted to post this in case it might help others who are going to get Docetaxel.

I just finished round six (final) of my Docetaxel infusions on 10/24. (Oct 2022, started July 2022). Here are some things that have helped me:

1. ⁠Stay hydrated. Drink lots of fluid before, during and after your chemo. Keep it up in the days after. Staying really well hydrated helped me quite a bit. The times (when it was warmer in July / August / September) when I didn’t keep up on hydration I felt much worse. It resolved with rehydration.

2. ⁠Ice your hands and feet during the infusion. This helps prevent neuropathy. I put ziploc bags of ice on my hands for 15 min at a time, let them warm up then repeated. For my feet, these were perfect.

SuzziPad Cold Therapy Socks &... amazon.com/dp/B09W5KLVDR?re...

The booties were great and perfect because you could easily keep them on even if you reclined. I got the mittens but found they weren’t as easy. Ice bags worked better for my hands than the mittens. I would not buy the mittens if I had to do it over.

3. I ate ice chips throughout the infusion as well to prevent taste disturbances.

4. Starting with infusion 3, I started taking 10 mg of Claritin once a day the day before, the day of and two days after. This seemed to help with the achiness I was feeling. Other people I know receiving chemo did this as well. I tried it and it worked well for me. Ask your doctor or nurse if it’s OK for you.

5. Hair: I chose to not do anything about the hair on my head. Some people will wear ice caps and other devices on their head. I just chose to buzz off all my hair once it started coming out. Some do it in advance. You’ll know when it’s right for you. Mine started coming out 2 weeks to the day from my first infusion. I went down to the barber, had them take it all off, cried a bit in the car then went to my favorite bar and had a shot and a margarita with my husband.

Body Hair: Yes it thins (eyebrows, chest / belly, pubes) but it took longer than head hair for me.

6. Dry skin. Your skin is going to get more dried out from the chemo as well as from the lack of testosterone from the Lupron shots (skin oil production goes down). Use good moisturizer twice a day and SPF 50 sunscreen on your face. (Even though I have been out in the sun a lot, my skin got really sensitive to the sun.). This made a big difference for me.

7. Stay active. I think this is one of the most important things that really helped me. I have consistently walked 5-7 miles a day since my diagnosis as well as going to the gym when I can. Even on the days of chemo and after, I kept walking. I just went in the morning when I had energy. Even if you are tired, get out and walk some. Even if you can only do a few blocks, do it and work up to more.

8. Fatigue: I got my infusions on Monday and every three weeks thereafter. (Always on a Monday.). I felt fine Monday after and Tuesday AM. I started to hit the wall Tuesday PM. I was pretty wiped out the rest of the week and start to feel better by Friday or Saturday. The rest of the time after that, I felt pretty good. You’ll learn your pattern. Work and walk when you have energy. Rest when you need to. Stay hydrated!!!

9. Get your flu shot, COVID booster and pneumococcal vaccines taken care of before you start chemo. Your immune system response drops off when on chemo so do the vaccinations before or wait until a few weeks after your last infusion. I hadn’t considered pneumococcal vaccine due to my age (52) but they said I needed it because they considered me high risk due to chemo and cancer. Ask your doctor and do your vaccines they suggest before you start.

10. Pay close attention to hand washing , wearing a mask to protect yourself and food precautions (no undercooked eggs, no blue cheese or soft cheeses like Brie or cotija cheese, no sushi, no smoked fish, no rare meat) while on Chemo. Pay attention to what they tell you about getting care when you have a fever or other symptoms.

PM me if you have more questions or want to chat. Always happy to help!

[GoBucks]

Ok then Alvin. Great summary.

[Gl448]

Fantastic post. Going to save it for when I start triple therapy soon.

I shave my head just for convenience already, so no ice cap for me, but am concerned about my facial hair. You didn’t mention how quick it was impacted.

[AlvinSD in reply to Gl448]

Facial hair didn’t really seem to be impacted. Not sure why. Would have been nice to have a benefit and give up shaving.

[Gl448 in reply to AlvinSD]

I make a small amount of money with my beard and body hair, modeling and the like, so no benefit for me if they get to thin.

Thanks.

[CAMPSOUPS in reply to Gl448]

In our younger years my wife would curiously ask if winning the lottery would I ever have plastic surgery. NO Way. EXCEPT I would have laser ear hair removal. That I would do. Well during chemo I experienced no ear hair. That was nice ha.

I did loose my facial hair during chemo. Goatee gone. Mustache portion has never fully come back and beard is different texture and sparse. Some or a lot of that has to do with adt though.

3 YRS POST DX AND 3 YRS POST CHEMO

[Tall_Allen]

Thanks! I'm saving this.

[Izzygirl1]

Thank you! My husband is doing triple therapy currently. I wish he had his flu shot before he started chemo. Do you think closer to his next treatment or shortly after the next one is the best time to get it? He gets his docetaxel every three weeks.

[AlvinSD in reply to Izzygirl1]

My MO said wait 2-3 weeks after my last infusion for my flu shot. (Same time when he said I could start eating things like smoked salmon, blue cheese, etc. again.)

[CAMPSOUPS]

Thank you Alvin. Well put together.

Did you need a WBC promoter (Neulasta) for example to boost your WBC's ?

The Claritin is commonly the first recommendation for the pain and restless leg symptoms that come from it (Neulasta etc.). Although the Clairton doesn't work for me.

Further I can't tell of course how much of my pain and discomfort during crash days comes from the chemo or from the Neulasta.

[Seasid in reply to CAMPSOUPS]

Claritin

they didn't gave me any WBC promoter. I asked professor Epstein for it and he said that I don't need it.

[CAMPSOUPS in reply to Seasid]

I needed it. Blood test was conclusive. And I felt the effects of not having it big time.

Unfortunately it may add in my case to significantly worse side effects during the chemo crash.

[Seasid in reply to CAMPSOUPS]

our member Brysonal had blood transfusion in order to compensate for the lost immunity. In US they are not doing that?

i am not a doctor just wondering?

[AlvinSD in reply to CAMPSOUPS]

No Neulasta or similar drugs for me. My neutrophils get very low about 7-10 days post infusion but then bounced back to my normal level before the next cycle. My platelets were not affected.

[CAMPSOUPS in reply to AlvinSD]

Thank you. Interesting the Claritin (antihistamine) seems so commonly advised and in your case even without the Neulasta.

[Seasid in reply to AlvinSD]

i was only tested just before the next cycle, therefore I don't know how my blood developed 7 days after the chemo infusions.

[CAMPSOUPS in reply to Seasid]

Blood labs the day of or day before etc. infusion is standard.

[Seasid in reply to CAMPSOUPS]

but our member AlvinSD knows his blood count 8 days after the chemo infusion

[AlvinSD in reply to Seasid]

From studies of people receiving chemotherapy they know, in general, that the neutrophil counts are at the lowest 7-10 days post infusion. I did know what mine were but they fit the pattern of what is typically seen. The pre-chemo labs are just to make sure you have recovered enough that the next infusion is going to not be unsafe. If the neutrophils are not high enough they may delay the chemo infusion or give you something to stimulate your neutrophils production like Neulasta.

[Seasid]

i am 4 years in front of you and I am only now concidering radiation to my prostate.

my nadir PSA was 0.12 and about a year ago my PSA started to rise from 0.2 up to 1.5 now.

I just had a 68Ga PSMA PET scan and the SUV max value of my prostate is 14.

i also had a FDG PET scan to confirm concordance.

i also had a nuclear medicine bone scan.

it looks that 4.5 years after my initial diagnosis with 15 bone mets now I don't have any mets on any of these scans.

I may be doing MRI Linac soon.

the theory is that maybe just a cancer in my prostate is now CRPC.

i am only on Degarelix injections now.

the PSA doubling time is about 2 to 3 months now.

i was told by my RO professor Izard to contact RO when my PSA starts to rise.

i am treating myself in my local in Darlinghurst in Sydney.

where are you located and where are you treating yourself?

even now the RO said to me that according to the Stamped trial I will not have any survivor benefits from radiating my prostate, but that I could avoid lot of problems by avoiding local spread of my prostate cancer around my prostate. It could spread now to the rectum, bladder etc

after radiation I will stay on Degarelix injections only as my mets are still hormone sensitive.

[AlvinSD in reply to Seasid]

I am in San Diego and a patient at Kaiser Permanente and UC San Diego.

[anony2020]

Very good info. Thanks.

Do you need RT on top of Chemo and ADT+? Just wondering.

[AlvinSD in reply to anony2020]

Yes. RT is my next step starting in December

[rsgdmd]

Just finished my 6th & experienced much the same. Did find I lost my nose hairs by #4, which gives me a chronic runny nose. Facial hair became virtually non-existent - chemo? ADT? Also get a lot of tearing from the eyes at times.

I did become extremely neutropenic after #1 & got Ziextenzo (bio-equiv. to Neulasta) for each round after. Also got thrush a couple days after each round, likely from the steroids.

Finally, have found that Zyrtec (taking rather than Claritin) has really helped with hot flashes and have continued taking beyond the first few days after chemo.

[Seasid in reply to rsgdmd]

i also have tearing from my eyes even now, but I am not sure if it is still from the effects of the chemo?

[Seasid in reply to rsgdmd]

i didn't take any Prednisone during my Docetaxel chemotherapy. It was prescribed, but I read some Finish studies with docytaxel chemotherapy and they didn't use Prednisone (only dexamethason before and during chemotherapy,)

on that information I made a decision not to use Prednisone at all. (I only used Prednisone for 11 days and after reading the Finish studie I stopped taking Prednisone)

They were not happy that I am not using Prednisone but I said myself that the Finnish oncologist know what they are doing.

[rsgdmd in reply to Seasid]

I took 4mg dexamethasone in the morning, the day before, day of & day after. Also given 14 mg about 20 min prior.

[Seasid in reply to rsgdmd]

did you take Prednisone everyday during your whole cycle? (I didn't)

[rsgdmd in reply to Seasid]

no prednisolone, just as described

[Seasid in reply to rsgdmd]

who advised you not to take daily Prednisone during your chemotherapy? I believe it was approved with daily Prednisone?

[rsgdmd in reply to Seasid]

Im not on abiraterone at present nor during chemo. Maybe that's what you are talking about. Had to stop it right before starting because it caused my bilirubin to go way up. Now that chemo is done, will be trying it again, starting at 1/ 2 dose, with prednisolone.

[AlvinSD in reply to Seasid]

(My response is based on the protocols at my facility based in the US)

They said that for Castration Sensitive PC, they use Docetaxel and dexamethasone. I took oral dexamethasone the day before infusion, the day of then my last dose the morning after my infusion.

For castration resistant they said they use Docetaxel and prednisone.

I’m not sure why there is a difference

[Seasid in reply to AlvinSD]

i totally agree with you

i didn't use Prednisone for my early Docetaxel chemotherapy (HSPC).

i also used dexamethason like you.

in my hospital they asked me to use daily Prednisone during the chemotherapy plus dexamethasone before and on the day of the Docetaxel infusions.

they prescribed me Prednisone and dexamethasone

i refused to take daily Prednisone based on the information from the Finnish study with Docetaxel.

interesting

i am wondering what they are using now in my hospital?

[Mrtroxely in reply to Seasid]

intresting

you had 6 chemo doxetaxel

all 6 no prednisone???

what do you think the bnifit to health is with it and without it? Have you got link to finish study?

i been questioning it, they say it's 1. For appititite. 2. To help adjust the immune response to doxetaxel????

how do you think it helped you not taking it. How did you feel?

also what was your dexamethasone regime???

thank you, intresting reading real life

[Seasid in reply to Mrtroxely]

i was doing early Docetaxel chemotherapy. Are you HSPC?

[Seasid in reply to Mrtroxely]

i did the dexamethason according this instructions and also the early Docetaxel chemotherapy. Dr Fred Saad:

urotoday.com/journal/everyd...

[Seasid in reply to Mrtroxely]

i developed grade one peripheral neuropathy after 6 cycles of Docetaxel chemotherapy treatment but it is ok now.

somebody said that in US they give you early chemotherapy for HSPC without Prednisone but for a CRPC with Prednisone.

i also don't know what is the difference. I will ask in my hospital

[rsgdmd]

From ncbi.nlm.nih.gov/pmc/articl....

Ocular adverse events of docetaxel include epiphora (excess tearing) and conjunctivitis. Epiphora has been reported to be associated with canalicular and nasolacrimal duct stenosis, but it is not necessarily caused by lacrimal duct obstruction.

[dico]

Thank you! This will be so helpful when the time comes for my husband.

[spencoid2]

thanks, i am printing this list. just started doxy. you must have small feet, the booties you link could not fit at all on my size 10.5 to 11 feet. Amazon ended up refunding my money and letting me keep them. I made my own booties out of wet suit material and they worked quite well. i then make some mittens as well since the Suzi things are not insulated. we live 4 hours from the cancer center and stay over the night before so no way to keep the ice cold depending on crappy motel refrigerators. so i bought a cute little 20 quart AC/DC (works in car or home) freezer/refrigerator and it worked well the first time at least. i had do move it into the infusion room with a wheelchair. i got the freezer for about $170 after negotiating

ebay.com/itm/123829560724

[Gl448 in reply to spencoid2]

Those booties come in two sizes, S/M and L. The large size supposedly fits men 10-14. Did you order the large?

[Gl448]

I may have to ice my face! 🤣

[CAMPSOUPS in reply to Gl448]

I re-entering chemo again after having it 3 years ago. I told my wife maybe I can hold an ice pack to my beard. I was only half kidding.

[Seasid]

are you getting 10 infusions of Jevtana now?

[Seasid]

why not Jevtana?

[CAMPSOUPS in reply to Seasid]

I'll try to remember to answer with long story but short story my PC cells show a selectivity to being destroyed by Docetaxel. I have lymph most of torso and bones mets skull to shins. There was stabilization over the last three years but progression showed up a couple months ago.

[Seasid in reply to CAMPSOUPS]

why do you believe that Jevtana chemotherapy wouldn't be better for you?

[CAMPSOUPS in reply to Seasid]

Docetaxel is more selective in killing my PC cells. Jevtana would be more selective for someone else's PC cells. A lot of this is determined by my response 3 years ago. Also backed up by trials and what has become common knowledge. But again for some Jevtana is better. The world of genetics, mutations, selectivity, on and on. You know that.

[Seasid]

sorry? Could you please explain what is systemic radium tx's?

[spencoid2]

yes large and they were marked large individually. reading the reviews after the fact others had problems, they did not fit over size 10. also they and the mittens have no insulation so do not last very long. just adding a layer of wet suit material makes them last three times as long.

[CAMPSOUPS in reply to spencoid2]

I did a brief scan of the Amazon page and or switched to a similar boot and had to scroll to the bottom of the page to see 3 size range choice which maxed out at mens size 14.

[spencoid2]

i ended up getting another thing that would fit anything but it still does not have insulation. Other than the fact that I needed cold packs, my little boot I made in about an hour for two works better. I did not line it so it needs a sock. The mittens are lines with merino wool jersey. I am finally getting to use up some of the cool fabrics I have had for 30 plus years (probably 40 plus) not that i need it but can you give a link for the larger booties?

[Mrtroxely]

yo dude.

thank you, great post.

my dx and age very similar.

im starting chemo number 2 in 3 days time, my hair and sentiments to my hair seem similar.....I'm at the teary eye stage pre buzz cut!!!!!

but your point number 10 about the foods?

why is that? I need radically change my thinking around food. I eat what I think is healthy, but it needs changing......you've probly experienced the knotted stomach and running to the loo with strange coloured p........

[AlvinSD in reply to Mrtroxely]

Thank you. For #10 and the food: I put this because of how Docetaxel causes your neutrophil (infection fighting white blood cells) counts to drop post infusion. Typically this occurs and they are at the lowest levels 7-10 days after you receive chemo. (My neutrophil count is normally around 3000 and a week after chemo would go down to 400-500. ). Because the neutrophil counts decrease, you are at increased risk of infection during this time. They advise people to take precautions to reduce the risk of infection. This includes avoiding some foods which carry more risk for people with weakened immunity during chemo due to potentially higher levels of bacteria (raw or smoked fish, undercooked eggs, raw or rare meat) or mold / fungus (blue cheese, soft cheeses like brie). If you get an infection when your neutrophils are low, it can be very dangerous which is why they also say if you get a persistent fever to seek medical care right away.

Some people’s neutrophils don’t recover on their own so they will need additional medicines (Neulasta, Neupogen etc) to try and increase the counts. Fortunately, mine recovered just fine.

[Seasid]

how did you know your blood count 7 days after the chemo infusion?

[AlvinSD in reply to Seasid]

I work in that area and lab science is what I do professionally.

[AlvinSD]

When people get chemotherapy, different types of blood cells can be impacted: white blood cells/neutrophils, red blood cells (hemoglobin/hematocrit) and platelets. If they give a transfusion, it’s usually because your hemoglobin (red blood cells) is getting too low. If your platelets get too low, one option might be to do a platelet transfusion. It is extremely, extremely rare now to give transfusions of neutrophils now because of the use of things like Neulasta.

As I mentioned my neutrophils would drop 7-10 days out then recover. My hemoglobin has dropped from about 15.5 before I started treatment to about 13.5. (I think this is likely due to the effects of the ADT rather than chemo.). My platelets dropped a very small amount but were basically still normal.

The pre-chemo complete blood count (CBC) checks all of these counts to make sure they are safe enough to continue with your next infusion.

[CAMPSOUPS in reply to AlvinSD]

Yes, correcto. Basically what I was saying. Thanks.

[Seasid]

well, according to my first oncologist professor Richard Epstein Xofigo is not a systemic therapie.

for me personally (i am not a doctor) even Lutetium 177 is not a systemic therapie. It only fights PSMA positive cancer under certain condition. According to the information from the Hofman team, only if the cancer is less than 200 ml and the SUV max is above 10.

i am just repeating myself.

clinical trials save money. Don't go there without great need. You will get an inferior treatment with the goal to approve the drug.

you are like a soldier in a battle during the first world war. You have to die in order to the pharmaceutical company to succeed.

have a look of our member profile. He received white blood cells during chemotherapy. Nothing similar what you are trying to explain like that it is only an emergency.

well, everything depends about how good is the medical advice you receive.

i hope that helps

[CAMPSOUPS in reply to Seasid]

Its a generalization Dr., professor, instructor Seasid.

Compared to any spot radiation its systemic.

Yes your definition is the accurate one to most degree. Your personal rants against trials are not appreciated though.

[Seasid in reply to CAMPSOUPS]

i am considering trials but I am disappointed with them.

in a trial setting I would not be able to receive a best care.

you are welcome to go to the trial

i am now paying rather than to go to the trial in order to get a better results

Xofigo is not a systemic therapie even if you try to present it that way.

Xofigo would not fight your cancer.

i was saving money for Xofigo in order to get some pain relief.

i believe you are trying to present things the way what they are not.

i am not a doctor only listening what they are saying to me.

Hope you will receive a best medical advice possible. I can see that lot of people here did not receive the best advice. I really hope that you are receiving a good advice. yourself

Where are you treating yourself?

[CAMPSOUPS in reply to Seasid]

In the states best care comes under a trial. Ask anyone!

[CAMPSOUPS in reply to Seasid]

Im not treating myself thanks.

I am not interested in your intentional innuendoes'' and gamesmanship.

[TeleGuy]

This is a great list, thank you so much! I wasn't as aggressive with sucking ice chips on my most recent chemo round and can barely taste at all! Have to keep on it!

I have been using the NatraCure cold therapy mittens along with the same brand of socks during the infusion and have been quite happy. The only problem with the mittens is that they don't have refills so if you want longer time on them you have to buy two sets (which I did).

[icanwintwice]

Im about to start docetxal myself. Im able to have sex post Lupron, Zytiga, amd radiation. Any chance post chemo sex in the equation?

[AlvinSD]

if you are able to have sex post Lupron/Radiation, IMO you should be OK post chemo. Chemo has not been as impactful for me as Lupron was.

[Ramp7]

Great info. I've instituted a hiking agenda as well. 7 miles each morning. With Winter coming I have concerns. Back to the rower.

[Jdhanoa]

Hi AlvinSD,

Thank you for providing such a comprehensive list. My dad is starting chemo so we bought many of the things you suggested. Quick question regarding the icing of hands and feet, how long did you ice them for? I noticed on the suzzipad it said not to use more than 20 min? Thank you

[ICancerVive]

Very helpful, thank you!

[ELOfan]

Alvin, Thanks I am packing a small roller-bag to take to chemo so I printed out your list. I added a phone-charger, and earbuds, earplugs in case I wanna sleep and the horseshoe-shaped neck-pillow that lets you sleep sitting on a plane and a soft lap blanket. To hydrate I'm packing an INSULATED water bottle that I can add ice to instead of messing with ice ships. I wonder if i could bring a few ice pops or those slurpy-things in plastic that are frozen? Honey Throat lozenges to suck on, chapstick.