Strong negative reaction to first Docetaxel treatment

[4tunate1]

I am participating in an NIH study combining Docetaxel with an immunotherapy. I had my first treatment of only Docetaxel this Tuesday. I lasted 2 minutes and 7cc before I had a severe reaction - severe flushing (glowing red from head to toe), difficulty breathing, sweating, uncontrollable shivering. EKG and all vitals remained pretty steady. HR spiked to 140 or so. I was immediately backed out of the chemo and IV Benadryl and hydrocortisone were given. It took me 1.5-2.0 hours to recover. Went home and was still pretty banged up yesterday, feeling much better this morning.

This was a traumatic experience for someone not familiar with such things. I wasn't going to die as I was in very good hands, but in the moment I certainly thought I might. We are waiting on feedback from NIH on what happened and if I can remain in the trial. I know there are some medicinal steps that can be taken to prevent this, but not sure if they interfere with their study. If so, that's fine as we can continue locally with my MO if we decide to continue.

I have responded extremely well to ADT with Lupron, prednisone and Zytiga. PSA from 466 to <.10 between February and May. Should I attempt to continue chemo? I am probably willing to try again with some preventative measures thrown in but cannot go through again what I experienced this week.

Interested in thoughts on what happened, why and what can be done to prevent. Also, will preventative steps truly help? What is the load on my organs when this happens? I'm just really confused after months of emotional and mental prep on risk/benefit of trying again or bowing out of chemo for now.

TYIA

[MJCA]

WOW. Not a great experience. In my first few rounds of Docetaxe, I was given 2 Benadryl orally. Were you given this prior to your infusion?

[4tunate1 in reply to MJCA]

No. Nothing was provided prior to infusion other than the steroid bag.

[MJCA in reply to 4tunate1]

Wow. Different than my experience. Sorry to hear.

[kiteND]

They should give you Benadryl before the infusion next time. If it happens again, you probably are allergic to docetaxel and should not try a third time. That is what happened to me.

[4tunate1 in reply to kiteND]

Thanks. I'm willing to try again with Benadryl or other precautions in advance. And yes, if it happens again, I'm out.

[Tall_Allen]

Was it an allergic reaction?

[4tunate1 in reply to Tall_Allen]

(Using reply insread of post) Idon't know officially. I believe it was. Perhaps anaphylactic or anaphylactoid. Per physician, Docetaxel contains a vehicle known as polysorbate 80 which has been shown to induce histamine release and cause infusion-related reactions. A reaction could also be caused by the Docetaxel itself (not the vehicle) so it's difficult to be 100% clear on the exact cause.

Spoke with the study lead last night. He is very honest and says he doesn’t know what happened. Says it wasn’t an allergic reaction based on vitals. I totally disagree based on my having gone through it. He is advising I postpone chemo until later on, if needed. I will discuss with my local MO. If I proceed with chemo I will do it locally outside of the study and insist on pre-test and precursors to prevent this from happening again. Taxanes may just not be tolerable for me.

[4tunate1]

I don't know officially. I believe it was. Perhaps anaphylactic or anaphylactoid. Per physician, Docetaxel contains a vehicle known as polysorbate 80 which has been shown to induce histamine release and cause infusion-related reactions. A reaction could also be caused by the Docetaxel itself (not the vehicle) so it's difficult to be 100% clear on the exact cause.

[PChater in reply to 4tunate1]

I had the same reaction to my Docetaxel infusions. They increased my pre meds of Benadryl, Pepcid, and dexamethasone on my second attempt and slowed the infusion time to 2 hours still had bad reaction with near syncope after only a few minutes into the infusion. My treatments were discontinued, but recently I was started on cabzitaxel infusions. I’ve completed 3 infusions with no reactions.

[dhccpa in reply to 4tunate1]

Just so you know, you have to hit Reply option to reply to TA. If you just post an answer, he might not see it.

[carbide]

We never know how our body will react to a drug.Totally your call whether to continue.

I got osteonecrosis of the jaw from Xgeva,

3% odds - they say.

Best luck brother. 👍

[4tunate1 in reply to carbide]

Sorry to hear that carbide. Just got my first Prolia shot last week so now I’m on the lookout for osteonecrosis, too. Stay strong!

[carbide in reply to 4tunate1]

Prolia (Denosumab) & Xgeva have same active drug Denosumab. Xgeva is the "stronger" of the two. Odds are 97% you will Not get osteonucrosis.I do question how much bone builders/ strengtheners really help. I feel Prolia is way over SOLD.

Best luck.

😁👍

[catsup]

I went thru the same experience at my first Doxi infusion. I too thought I was going to die. The infusion was stopped immediately. They immediate stabilized me . A week later I tried again.one of the problems. So for the was the speed at which they delivered the doxi. The other was my allergies to Doxi. So for the 1st 15 mins they started at the lowest speed of delivery. That let my body get used to the incoming Doxi and the gave me benedryl. All went well after that.

Hope you can sort all your issues before the next dose.

God bless

[4tunate1 in reply to catsup]

Good to hear it worked well for you with the low flow and the benedryl. Hopefully, we'll decide on a path forward next week.

[j-o-h-n]

I figure if that was me..... I probably would have done a tribal war dance around the room yelling obscenities and looking for my tomahawk.

I'm into humor and your ordeal ain't funny.... You have two sons to take of and of course we all want to see you around for a very very long time. So please heed the advice from member's posts (above) and make sure you have many doctors around while you're being treated for the second time. God Bless.

p.s. I can teach you how to perform a tribal war dance.

Good Luck, Good Health and Good Humor.

j-o-h-n

[4tunate1 in reply to j-o-h-n]

I appreciate the humor j-o-h-n. If it wasn't for the fact that I now know what a roach feels like after a shot of bug spray! We'll figure out what works and move on to it!

[j-o-h-n]

"I now know what a roach feels like after a shot of bug spray!"

I feel your pain, after all, I've lived in NYC all my life............

Good Luck, Good Health and Good Humor.

j-o-h-n

[Yank66]

DH had an allergic reaction to Docetaxel on his first infusion. It was scary, but not as severe as yours. Nurses and doctors came running. They stopped the Docetaxel, started steroids and Benadryl. Things simmered down and his MO decided to wait an hour and rechallenge the treatment the same afternoon, reducing it to 80%, slowing it down, adding more steroids and Benadryl and keeping a very close eye on him. I was a nervous Nellie, but had we waited a week for the second treatment, we would have been more than hesitant to keep going. They always premeditated him and he tolerated it well after that initial reaction. Our best wishes to you.

[KWman]

I have been on Lupron with Aberateron or Zytiga for over 4 years with continued good results. I was being treated at Sparrow in Lansing MI but am now at Memorial Sloan Kettering (satellite) at Basking Ridge in NJ. I have learned at MSK where this being studied that there is a class of super-responders to this immunotherapy and I am in this class. They are working on what is it that distinguishes this class. My PSA has been undetectable for over three years......

[4tunate1 in reply to KWman]

Interesting. Can you share more on who the 'super-responders' are? What classifies them as that? Are they being studied formally? Given my doctor's reaction to my response that makes me wonder if I'm (hopefully) in that class. But it's only been 3 months so...

Glad to hear you are in that group and being studied as a result!

We formally decided with my MO to not pursue chemo yesterday. I was very happy to hear a firm, declarative "no, I do not recommend this for you" as so many of the responses I get are a little more wishy-washy. So, for me, chemo is out for the foreseeable future. I'm OK with it. Moving on.

[March1124]

This has happened to my Dad. The first infusion it was a near immediate reaction just like yours, when they restarted the infusion he did just fine.

He just finished his 4th infusion this past week. He continues to have an adverse reaction each time though none as strong as the first. They give him Benadryl through an iv and slow the drip. The second he starts to have a symptom, they stop, restart and he is okay

Nurses said they have never had this happen to a patient four times in a row. My dad tries to make us feel like it is no big deal but I know the stress and fear are more intense than what he is leading us to believe. I am sorry you had such a frightening first experience. It’s traumatic to watch, I can only imagine how it must feel

[4tunate1]

Your Dad is very brave to continue and it’s great he is handling it with his care team. I am not totally clear why but they won’t let me continue as they don’t know what it was for me. Not allergic per my vitals, they said.