Treatment Name: Cisplatin + Docetaxel

Cisplatin + Docetaxel is a Chemotherapy Regimen for Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)

How does cisplatin + docetaxel work?

Each of the medications in cisplatin + doectaxel are designed to slow the growth of and kill lung cancer cells.

Goals of therapy:

Cisplatin + docetaxel is given to shrink lung tumors and decrease symptoms of lung cancer. It can be given either after surgery to eliminate microscopic cells, or it can be given before surgery to shrink the size of the tumor and minimize the size of the surgery.

If there is no metastatic disease (cancer in lung only and not other parts of the body), cisplatin + docetaxel is commonly given with the goal of cure.

If metastatic disease is present (cancer has spread to other areas of the body), cisplatin + docetaxel is not commonly given with the goal of cure, but rather to shrink tumors and decrease symptoms from lung cancer.

Schedule

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How is cisplatin + docetaxel therapy for NSCLC given?

  • Cisplatin intravenous (I.V.) infusion over 2 hours on Day 1
  • Docetaxel I.V. infusion over 1 hour on Day 1

Estimated total infusion time for this treatment:

  • From 4 to 5 hours for each cycle. Typically, I.V. hydration is given both before and after cisplatin and I.V. magnesium can add up to two hours
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time

Cisplatin + docetaxel is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, it may be given in the hospital if someone is too sick for an outpatient infusion visit.

Cisplatin + docetaxel is repeated every 21 days. This is known as one Cycle. Each cycle may be repeated up to 4 times, depending upon the stage of the disease. Duration of therapy may last up to three or four months, depending upon response, tolerability, and number of cycles prescribed.

Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects of cisplatin + docetaxel are shown here. Side effects sometimes have percentage ranges [example: 39 – 52%] because they differed between clinical studies:

Importantly, not all people who experience a side effect from cisplatin + docetaxel will experience it in the same way. It may be mild in some or severe in others, depending upon the individual. Everybody is different. Additionally, side effects may vary over time. For some, side effects may be a reason to delay or switch treatment, reduce the dose, or avoid treatment with a certain medication altogether.

Side effects may be treatable when they occur or preventable by taking certain medications before they happen. When medications are taken to prevent a problem, this is known as prophylaxis, or "prophy" for short.

After starting treatment with cisplatin + docetaxel, be sure to come back and watch all of the side effect videos shown below. Each of these videos contain valuable information about side effect management that will hopefully help you to both feel better and stay out of the hospital.

Watch videos on common cisplatin + docetaxel therapy side effects below

Side effect videos Side Effect Videos
AnemiaAnemiaNausea and VomitingNausea and VomitingHair LossHair LossFatigue Fatigue DiarrheaDiarrheaBleedingBleedingConstipationConstipationNeutropenic FeverNeutropenic Fever

Monitoring

How often is monitoring needed?

Labs (blood tests) may be checked before each treatment and periodically in between cycles. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), blood magnesium levels, blood potassium levels, plus any others your doctor may order.

How often is imaging needed?

Imaging may be checked before treatment, at the completion of treatment, or during treatment at your doctor’s discretion. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans.

How might blood test results/imaging affect treatment?

Depending upon the results, your doctor may advise to continue cisplatin + docetaxel as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.

Questions to Ask Your...

A better understanding of your treatments will allow you to ask more questions of your healthcare team. We then hope that with the answers, you will get better results and have greater satisfaction with your care. Because we know it's not always easy to know what questions to ask, we've tried to make it easy for you!

Choose any healthcare provider below to see common questions that you may want to ask of this person. Then, either print each list to bring to your clinic visits, or copy the questions and send them as a message to your healthcare team through your electronic medical record.

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Questions to ask your DoctorNursePharmacist

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        Questions to ask your NurseDoctorPharmacist

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              Questions to ask your PharmacistDoctorNurse

                    ChemoExperts Tips

                    What are the most important things to know about cisplatin + docetaxel while receiving therapy?

                    • You may have an allergic reaction while the docetaxel is being given. To prevent this, you will be given a steroid called dexamethasone to take at home before coming for your treatment. This medication is typically taken for 3 consecutive days starting 1 day prior to treatment
                    • Cisplatin can possibly damage the kidneys. Be sure to maintain good hydration to lessen the risk of experiencing kidney damage
                    • Depending on the results of blood tests (labs) you may need extra I.V. infusions of magnesium or potassium. This can make your total infusion time for the day increase by 2 hours or more. It is best to start this regimen early in the day if extra infusions are common for you
                    • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately.
                    • Clinical trials may exist for lung cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications.

                    Patient Assistance & Co-payment Coverage

                    Patients under the age of 65 years, or those with private insurance plans:
                    If you have insurance and are looking for patient assistance or copay assistance for Cisplatin + Docetaxel, we have provided links that may help.

                    Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Cisplatin + Docetaxel. Depending upon your income, they may be able to help cover the cost of:

                    • Cisplatin
                    • Docetaxel

                    For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

                    • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

                    Medicare and Medicaid patients (Patients 65 years or older):
                    The clinic providing treatment will likely pre-authorize medications and immune therapies such as Cisplatin + Docetaxel and are the best source to help you understand drug cost.

                    • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

                    Emotional Wellness

                    What is Emotional Wellness?
                    Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

                    Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

                    Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

                    Learn more about pursuing emotional wellness while receiving treatment with Cisplatin + Docetaxel

                    Individual Drug Label Information

                    Cisplatin (Platinol®)

                    • Cisplatin is an intravenous (I.V.) infusion that is typically given over one to two hours
                    • Cumulative toxicity to kidneys from cisplatin can be severe 
                    • Other toxicities from multiple doses are:  low blood counts, nausea, vomiting, and hearing loss
                    • Dosage adjustments may be required for poor kidney function or bone marrow toxicity (low blood counts) 
                    • Cisplatin is hazardous to a human fetus; women should avoid pregnancy while on this drug 
                    • Women should not breast-feed while on cisplatin; it has been reported to be in human milk 
                    • Patients on anticonvulsant drugs may have decreased levels while on cisplatin 
                    General Cisplatin (Platinol) Side Effects 
                    • Kidney problems (nephrotoxicity), especially in elderly patients. 
                    • Nausea and vomiting, both acute (within first 24 hours) and delayed (two to five days after infusion) 
                    • Diarrhea 
                    • Low blood cell counts (myelotoxicity, acute leukemia)
                    • Hearing problems- ringing ears.  All patients should have a baseline hearing test done.  All children should have hearing test done before each dose and for several years after therapy is complete 
                    • Low blood electrolytes:  magnesium, potassium, calcium, sodium, and phosphate
                    • Nerve pain 
                    • Vision problems; improvement and/or complete recovery usually occurs after stopping therapy 
                    • Liver toxicity; recovery usually occurs after stopping therapy 
                    • Click on the cisplatin (Platinol) package insert below for reported side effects and possible drug interactions

                    Side Effect Videos
                    Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue PainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

                    See DailyMed package insert.

                    Docetaxel (Taxotere®)

                    • Docetaxel is an intravenous (I.V.) infusion
                    • There is an increased  chance of death in patients treated with this drug who have poor liver function, are treated with higher doses, in patients with non-small cell lung cancer and a history of using other “platinum-based chemotherapy” drugs
                    • Docetaxel should not be given when a certain blood cell count, neutrophils, get below 1500 cells.  The physician may hold therapy or reduce the dose and continue treatment if this occurs
                    • Dosage adjustment may be required for poor liver function
                    • Severe fluid retention may occur, especially when combined with prednisone
                    • Docetaxel may interact with strong CYP3A4 inhibitors (e.g. ketoconazole) and proteosome inhibitors (e.g. Ritonavir) may increase concentrations of docetaxel and lead to increased toxicity or side effects. More frequent laboratory monitoring and docetaxel dosage adjustment may be needed
                    • Severe hypersensitivity may occur, although rare
                    General Docetael (Taxotere) Side Effects
                    • Hair loss
                    • Low red blood cell count and fatigue
                    • Nausea/vomiting
                    • Diarrhea
                    • Low white blood cell count and associated infections. Blood cell counts, including neutrophils (ANC) should be checked regularly
                    • Nail changes on fingers and toes
                    • Loss of sensation
                    • Swelling in the extremities
                    • Mouth sores 
                    • Changes in taste
                    • Loss of appetite
                    • Shortness of breath
                    • Muscle pain
                    • Tearing of eyes or vision problems
                    • Heart problems
                    • Click on the docetaxel (Taxotere) package insert below for reported side effects and possible drug interactions

                    Side Effect Videos
                    Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossFatigue Fatigue PainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

                    See DailyMed package insert.

                    References

                    1) Fossella F, Pereira JR, Pawel JV, et al. Randomized, multinational, phase III study of doxcetaxel plus platinum combinations versus vinorelbine plus cisplatin for advanced non-small-cell lung cancer: the TAX 326 Study Group. J Clin Oncol 2003; 21:3016–3024

                    2) Belani CP, Fossella F. Elderly subgroup analysis of a randomized phase III study of docetaxel plus platinum combinations versus vinorelbine plus cisplatin for first-line treatment of advanced nonsmall cell lung carcinoma. Cancer 2005;104;2766–2774

                    3) Tan EH, Rolski J, Grodzki T, et al. Global lung oncology branch trial 3 (GLOB3): final results of a randomized multinational phase III study alternating oral and i.v. vinorelbine plus cisplatin versus docetaxel plus cisplatin as first-line treatment of advanced non-small-cell lung cancer. Ann Oncol 2009;20:1249–1256

                    4) Kim YH, Kim JS, Choi YH, et al. Phase II study of docetaxel and cisplatin combination chemotherapy in metastatic or unresectable localized non-small-cell lung cancer. Int J Clin Oncol. 2002;7:114–119

                    5) Kubota K, Watanabe K, Kunitoh H, et al. Phase III randomized trial of docetaxel plus cisplatin versus vindesine plus cisplatin in patients with stage IV non-small-cell lung cancer: the Japanese Taxotere Lung Cancer Study Group. J Clin Oncol 2004;22:254–261

                    6) Georgoulias V, Ardavanis A, Agelidou A, et al. Docetaxel versus docetaxel plus cisplatin as front-line treatment of patients with advanced non-small-cell lung cancer: a randomized, multicenter phase III trial. J Clin Oncol 2004;22:2602–2609

                    Created: September 7, 2021 Updated: September 7, 2021

                    What is Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)?

                    What is Non-Small Cell Lung Cancer?
                    A disease of the tissue found in the lung.  Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Known causes include smoking and exposure to environmental toxins.  The stage of NSCLC can vary at diagnosis and throughout treatment.  Stages include stage I, II, III, and IV.  The effectiveness of the treatment may depend upon the stage at diagnosis.

                    NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

                    What does Cure mean?

                    The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

                    Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

                    Clinical Studies

                    1) Fossella F, Pereira JR, Pawel JV, et al. Randomized, multinational, phase III study of doxcetaxel plus platinum combinations versus vinorelbine plus cisplatin for advanced non-small-cell lung cancer: the TAX 326 Study Group. J Clin Oncol 2003; 21:3016–3024


                    2) Belani CP, Fossella F. Elderly subgroup analysis of a randomized phase III study of docetaxel plus platinum combinations versus vinorelbine plus cisplatin for first-line treatment of advanced nonsmall cell lung carcinoma. Cancer 2005;104;2766–2774


                    3) Tan EH, Rolski J, Grodzki T, et al. Global lung oncology branch trial 3 (GLOB3): final results of a randomized multinational phase III study alternating oral and i.v. vinorelbine plus cisplatin versus docetaxel plus cisplatin as first-line treatment of advanced non-small-cell lung cancer. Ann Oncol 2009;20:1249–1256


                    4) Kim YH, Kim JS, Choi YH, et al. Phase II study of docetaxel and cisplatin combination chemotherapy in metastatic or unresectable localized non-small-cell lung cancer. Int J Clin Oncol. 2002;7:114–119


                    5) Kubota K, Watanabe K, Kunitoh H, et al. Phase III randomized trial of docetaxel plus cisplatin versus vindesine plus cisplatin in patients with stage IV non-small-cell lung cancer: the Japanese Taxotere Lung Cancer Study Group. J Clin Oncol 2004;22:254–261


                    6) Georgoulias V, Ardavanis A, Agelidou A, et al. Docetaxel versus docetaxel plus cisplatin as front-line treatment of patients with advanced non-small-cell lung cancer: a randomized, multicenter phase III trial. J Clin Oncol 2004;22:2602–2609

                    What is a CBC?

                    A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

                    Common uses:
                    1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

                    2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

                    3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

                    What is a CMP?

                    A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status, 2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

                    Electrolytes & Acid/Base status:
                    1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

                    Kidney Function:
                    5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

                    Liver Function:
                    7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

                    Blood sugar:
                    13) Serum glucose

                    Calcium:
                    14) Serum calcium