Handling of Taxotere®

Taxotere® (docetaxel) is supplied in a clear glass vial with a red flip-off cap for the 80-mg vial and a green cap for the 20-mg vial. Diluent is supplied in a clear glass vial with a transparent colorless flip-off cap. Both items are provided in a blister pack in a single carton.1 Each vial is a single-use vial and should not be used for multiple doses.1

Strength Labeled fill
Taxotere® 80 mg 80 mg docetaxel per 2 mL polysorbate 80
Diluent (13% ethanol in water for injection) 6 mL*
Taxotere® 20 mg 20 mg docetaxel per 0.5 mL polysorbate 80
Diluent (13% ethanol in water for injection) 1.5 mL*

* Both the Taxotere® Injection Concentrate and the diluent vials contain an overfill to compensate for liquid loss during preparation. This overfill ensures that after dilution with entire contents (approximately 1.8 mL for Taxotere 20 mg and approximately 7.1 mL for Taxotere® 80 mg) of the accompanying diluent, there is an initial diluted solution containing 10 mg/mL docetaxel.1

Handling Precautions

Procedures for proper handling and disposal of anticancer drugs should be considered. Several guidelines on this subject, such as the following, have been published. However, there is no general agreement that all of the procedures recommended in the following guidelines are necessary or appropriate.1–7

  • As with all cytotoxic drugs, care should be taken when handling and preparing Taxotere.2 Taxotere® should be prepared in a class II biological safety cabinet using standard precautions for the safe handling of antineoplastic agents.2,3 Latex gloves are recommended.3 (Please refer to references 2–7 for further information on the safe handling of antineoplastic agents.2–7)
  • If Taxotere® concentrate or solution comes in contact with skin, immediately and thoroughly wash with soap and water. If contact is made with mucosa, immediately and thoroughly wash with water. 1,3–6
  • The disposal of unwanted Taxotere® solution should follow recommended procedures for the disposal of anticancer drugs.1

Supplies

The supplies needed for Taxotere® administration include the following8:

Materials Recommendation
Calibrated syringes Use smallest possible syringe and needle (e.g., for a 20-mg vial use a 3-mL syringe and a 19-gauge, 1.5-inch needle)
Bag/bottle*:
100 mL
250 mL
>250 mL
Use for doses of:
<80 mg
80 mg–200 mg
>200 mg
Administration sets Polyethylene-lined administration kits

* The concentration of the final dilution for infusion should be in the range of 0.3 to 0.74 mg/mL. This calculation includes the volume of the bag/bottle plus the volume of the drug added.1

NOTE: Filtration of the infuscate is not required.

Contact of the undiluted concentrate with plasticized PVC equipment or devices used to prepare solutions for infusion is not recommended. To minimize patient exposure to the plasticizer DEHP (di-2-ethylhexyl phthalate), which may be leached from PVC infusion bags or sets, diluted Taxotere® solution should be stored in bottles (glass, polypropylene) or plastic bags (polypropylene, polyolefin) and administered through polyethylene-lined administration sets.1

Storage and Stability

  • Unopened Taxotere® vials may be stored under refrigeration or at room temperature, 2°C to 25°C (36°F to 77°F). Store in their original package to protect from bright light.
  • Unopened concentrate and diluent vials of Taxotere® are stable until the expiration date indicated on the package when stored under proper conditions.
  • Contact of the Taxotere® concentrate with plasticized PVC equipment or devices used to prepare solutions for infusion is not recommended.
  • Freezing does not adversely affect Taxotere® concentrate.
  • Initial diluted solution is stable for up to 8 hours under refrigeration or at room temperature, at temperatures from 2°C to 25°C (36°F to 77°F).
  • Final solution for infusion is stable for up to 4 hours under refrigeration or at room temperature, at temperatures from 2°C to 25°C (36°F to 77°F).
  • Use Taxotere® initial diluted solution and Taxotere® final dilution for infusion as soon as possible after preparation.1

References

  1. Taxotere® Prescribing Information. Bridgewater, NJ: sanofi-aventis U.S. LLC; Rev.December 2006.
  2. American Society of Hospital Pharmacists. ASHP technical assistance bulletin on handling cytotoxic and hazardous drugs. Am J Hosp Pharm. 1990;47:1033–1049.
  3. Office of Occupational Medicine. Occupational Safety and Health Administration (OSHA). Controlling occupational exposure to hazardous drugs. Am J Health Syst Pharm. 1996;53:1669–1685.
  4. American Medical Association Council on Scientific Affairs. Guidelines for handling parenteral antineoplastics. JAMA. 1985;253:1590–1592.
  5. National Study Commission on Cytotoxic Exposure. Recommendations for handling cytotoxic agents. .
  6. Clinical Oncological Society of Australia. Guidelines and recommendations for safe handling of antineoplastic agents. Med J Aust. 1983;1:426–428.
  7. Jones RB, Frank R, Mass T. Safe handling of chemotherapeutic agents: a report from the Mount Sinai Medical Center. CA Cancer J Clin. 1983;33:258–263.
  8. Data on file, sanofi-aventis.


IMPORTANT SAFETY INFORMATION

WARNING:

  • The incidence of treatment-related mortality associated with Taxotere® therapy is increased in patients with abnormal liver function, in patients receiving higher doses, and in patients with non-small cell lung carcinoma and a history of prior treatment with platinum-based chemotherapy who receive Taxotere® as a single agent at a dose of 100 mg/m2 (see WARNINGS and PRECAUTIONS section of the prescribing information)
  • Taxotere® should generally not be given to patients with bilirubin > upper limit of normal (ULN), or to patients with serum glutamic-oxaloacetic transaminase (SGOT) and/or serum glutamic-pyruvic transaminase (SGPT) > 1.5 X ULN concomitant with alkaline phosphatase > 2.5 X ULN
    • Patients with elevations of bilirubin or abnormalities of transaminase concurrent with alkaline phosphatase are at increased risk for the development of grade 4 neutropenia, febrile neutropenia, infections, severe thrombocytopenia, severe stomatitis, severe skin toxicity, and toxic death
    • Patients with isolated elevations of transaminase > 1.5 X ULN also had a higher rate of febrile neutropenia grade 4 but did not have an increased incidence of toxic death
    • Bilirubin, SGOT or SGPT, and alkaline phosphatase values should be obtained prior to each cycle of Taxotere® therapy and reviewed by the treating physician
  • Taxotere® therapy should not be given to patients with neutrophil counts of < 1500 cells/mm3
    • In order to monitor the occurrence of neutropenia, which may be severe and result in infection, frequent blood-cell counts should be performed on all patients receiving Taxotere®
  • Severe hypersensitivity reactions characterized by generalized rash/erythema, hypotension and/or bronchospasm, or very rarely fatal anaphylaxis, have been reported in patients who received the recommended 3-day dexamethasone premedication
    • Hypersensitivity reactions require immediate discontinuation of Taxotere® infusion and administration of appropriate therapy (see WARNINGS AND PRECAUTIONS section of the prescribing information)
  • Taxotere® must not be given to patients who have a history of severe hypersensitivity reactions to Taxotere® or to other drugs formulated with polysorbate 80 (see CONTRAINDICATIONS section of the prescribing information)
  • Severe fluid retention occurred in 6.5% (6/92) of patients despite use of a 3-day dexamethasone premedication regimen. It was characterized by one or more of the following events: poorly tolerated peripheral edema, generalized edema, pleural effusion requiring urgent drainage, dyspnea at rest, cardiac tamponade, or pronounced abdominal distention (due to ascites) (see WARNINGS and PRECAUTIONS section of the prescribing information)

Additional Warnings

  • All patients should be premedicated with oral corticosteroids such as dexamethasone (see DOSAGE AND ADMINISTRATION section of the prescribing information)
  • Neutropenia (<2,000 neutrophils/mm3) occurs in virtually all patients given 60-100 mg/m2 of Taxotere® and grade 4 neutropenia (<500 cells/mm3) occurs in 85% of patients given 100 mg/m2 and 75% of patients given 60 mg/m2
  • Treatment-related acute myeloid leukemia (AML) or myelodysplasia has occurred in patients given anthracyclines and/or cyclophosphamide, including use with Taxotere® in adjuvant therapy of breast cancer
  • Taxotere® can cause fetal harm when administered to pregnant women. Women of childbearing potential should be advised to avoid becoming pregnant during therapy with Taxotere®
  • Patients with pre-existing effusions should be closely monitored from the first dose for possible exacerbation of the effusions.

Precautions

  • Localized erythema of the extremities with edema followed by desquamation has been observed
    • In case of severe skin toxicity, an adjustment in dosage is recommended (see DOSAGE AND ADMINISTRATION section of the prescribing information)
  • Severe neurosensory symptoms (paresthesia, dysesthesia, pain) were observed in 5.5% (53/965) of metastatic breast cancer patients, and resulted in treatment discontinuation in 6.1%
    • When these symptoms occur, dosage must be adjusted; if symptoms persist, treatment should be discontinued (see DOSAGE AND ADMINISTRATION section of the prescribing information)
  • Severe asthenia was reported in 14.9% (144/965) of metastatic breast cancer patients, but led to treatment discontinuation in only 1.8%
    • Symptoms of fatigue and weakness may last a few days up to several weeks and may be associated with deterioration of performance status in patients with progressive disease
  • In patients treated with TCF for gastric cancer, the incidence of serious adverse events was higher in patients >65 years than in younger patients. Adverse events (all grades) occurring at rates >10% higher in elderly patients included lethargy, stomatitis, diarrhea, dizziness, edema, and febrile neutropenia/neutropenic infection.
  • Taxotere® should be administered only under the supervision of a qualified physician experienced in the use of antineoplastic agents. Appropriate management of complications is possible only when adequate diagnostic and treatment facilities are readily available

Please see accompanying full prescribing information, including boxed WARNING.

Taxotere Indications

Breast Cancer
TAXOTERE® is indicated for the treatment of patients with locally advanced or metastatic breast cancer after failure of prior chemotherapy
TAXOTERE® in combination with doxorubicin and cyclophosphamide is indicated for the adjuvant treatment of patients with operable node-positive breast cancer

Non-Small Cell Lung Cancer
TAXOTERE®, as a single agent, is indicated for the treatment of patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) after failure of prior platinum-based chemotherapy
TAXOTERE® in combination with cisplatin is indicated for the treatment of patients with unresectable, locally advanced or metastatic NSCLC who have not previously received chemotherapy for this condition.

Prostate Cancer
TAXOTERE® in combination with prednisone is indicated for the treatment of patients with androgen independent (hormone refractory) metastatic prostate cancer.

Gastric Cancer
TAXOTERE® in combination with cisplatin and fluorouracil is indicated for the treatment of patients with advanced gastric adenocarcinoma, including adenocarcinoma of the gastroesophageal junction, who have not received prior chemotherapy for advanced disease.

Head and Neck Cancer
TAXOTERE® in combination with cisplatin and fluorouracil is indicated for the induction treatment of patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN).