Incidence of commonly experienced non-haematological adverse effects reported for treatment with<unk> . Data from 40 phase II and phase III studies (n = 2045) with patients undergoing a one-hour infusion of 100 mg/m2<unk>  once every three weeks. Incidence of severe adverse effects reported in patients treated with<unk> . Data from 40 phase II and phase III studies with patients undergoing a one-hour infusion of 100 mg/m2<unk>  once every three weeks.<unk>  is a cytotoxic chemotherapeutic agent. As with all chemotherapy, adverse effects are common, and many side effects have been<unk> umented. Because<unk>  is a cell-cycle-specific agent, it is cytotoxic to all dividing cells in the body. This includes tumour cells as well as hair follicles, bone marrow and other germ cells. For this reason, common chemotherapy side effects such as hair loss occur; sometimes this can be permanent. North west France are conducting a survey to establish exactly how many people are affected in this way. Independent studies show it could be as high as 6.3%, which puts it in the 'common and frequent' classification. Haematological adverse effects include neutropenia (95.5%), anaemia (90.4%), febrile neutropenia (11.0%) and thrombocytopenia (8.0%). Deaths due to toxicity accounted for 1.7% of the 2045 patients, and incidence was increased (9.8%) in patients with elevated baseline liver function tests (liver dysfunction). Taxane-induced pneumotoxicity is rare. However, 1–5% of patients taking<unk>  may develop severe pneumotoxicity. Patients may develop exertional breathlessness and desaturation which needs to be detected early. Chest X-Ray may show bilateral opacities and High Resolution CT chest may reveal Organizing Pneumonia (OP) pattern or Non-Specific Organizing Pneumonia (NSIP) pattern or a combination.<unk> -induced DPLD is a fatal adverse effect, which can be managed by the cessation of the drug and starting on steroids in adequate doses. Observations of severe side effects in the above 40 phase II and phase III studies were also recorded. Many more side effects have been reported for conjunctive and adjuvant treatment with<unk>  as well as rare post-marketing events. Contraindications and patient factors<unk>  is contraindicated for use with patients with a baseline neutrophil count less than 1500 cells/µL, a history of severe hypersensitivity reactions to<unk>  or polysorbate 80, severe liver impairment and pregnant or breast-feeding women. Side effects are experienced more frequently by patients of 65 years or older, but dosage is usually not decreased. Kidney failure is thought not to be a significant factor for<unk>  dosage adjustment. Patients with hepatic insufficiency resulting in serum bilirubin greater than the upper limit of normal (ULN) should not be administered<unk> , though this is not a stated contraindication. Dosage should be reduced by 20% in people who develop grade 3 or 4 diarrhea following exposure to<unk> , hepatotoxicity defined by liver enzymes at levels greater than five times the ULN, and grade 2 palmer-planter toxicity. Paediatric trials of<unk>  have been limited, and so safety of use in patients under 16 years has not been established. Pregnancy Based on the limited data available,<unk>  appears to be safe in pregnancy if administered during the second and third trimesters; however, maternal and fetal risks should be weighed against benefits to determine the appropriate course of action. As with all chemotherapeutic agents,<unk>  administered to pregnant animals causes a variety of embryofetal toxicities, including death, when given during the period of organogenesis. Yet adequate studies investigating maternal and fetal effects in humans are lacking. One small systematic review that examined the use of taxanes to treat breast cancer in pregnancy showed that, out of 19 patients, only three congenital malformations occurred. Two cases of cerebral ventriculomegaly observed in the study were<unk> umented prior to the administration of chemotherapy, suggesting an alternate cause of congenital malformation. The third case involved pyloric stenosis in an infant whose mother received a combination regimen of<unk> , doxorubicin, cyclophosphamide and paclitaxel; because the fetus was exposed to multiple drugs in utero, it remains difficult to identify<unk>  as the causative teratogenic agent. Further studies are needed to better assess the safety of<unk>  in pregnancy and determine appropriate dosing in pregnant women. Drug interactions Drug interactions may be the result of altered pharmacokinetics or pharmacodynamics due to one of the drugs involved. Cisplatin, dexamethasone, doxorubicin, etoposide, and vinblastine are all potentially co-administered with<unk>  and did not modify<unk>  plasma binding in phase II studies. Cisplatin is known to have a complex interaction with some CYPs and has in some events been shown to reduce<unk>  clearance by up to 25%. Anticonvulsants induce some metabolic pathways relevant to<unk> . CYP450 and CYP3A show increased expression in response to the use of anticonvulsants and the metabolism of<unk>  metabolite M4 is processed by these CYPs. A corresponding increase in clearance of M4 by 25% is observed in patients taking phenytoin and phenobarbital, common anticonvulsants. + Common and/or likely drug-drug combinations and known side effects from drug interactions Drug interacting with<unk>  Adverse effects from interaction Cisplatin Increased risk of delayed neuropathy Cyclosporine, dalfopristin, erythromycin, itraconazole, ketoconazole, quinupristin, terfenadine, troleandomycin Increased risk of<unk>  toxicity including some or all of the following: anaemia, leucopoenia, thrombocytopenia, fever, diarrhoea Doxorubicin hydrochloride Cholestatic jaundice and pseudomembranous colitis Doxorubicin hydrochloride liposome Increased doxorubicin exposure Vaccinations for Bacillus of Calmette and Guerin, measles, mumps, poliovirus, rotavirus, rubella, smallpox, typhoid, varicella, yellow fever Increased risk of infection by live vaccine Thalidomide Increased risk of venous thromboembolism Erythromycin, ketoconazole and cyclosporine are CYP3A4 inhibitors and therefore inhibit the metabolic pathway of<unk> . When used with anticonvulsants, which induce CYP3A4, an increased dose of<unk>  may be required. Pre-treatment with corticosteroids has been used to decrease hypersensitivity reactions and oedema in response to<unk>  and has shown no effect on the pharmacokinetics of<unk> . The efficacy of<unk>  was improved by treatment with oral capecitabine, and after more than 27 months follow-up the survival benefit has been confirmed. Doxorubicin was combined with<unk>  in one study of 24 patients and resulted in an increased AUC of<unk>  by 50 to 70%, indicating doxorubicin may affect the disposition of<unk> . Etoposide has also been shown to decrease<unk>  clearance, though patient numbers for this observation have been low. Prednisone given with<unk>  led to improved survival, quality of life and pain management in patients with hormone-refractory prostate cancer.
Docetaxel
Paclitaxel
Doxorubicin
Trastuzumab
Ifosfamide
Lipoplatin
Ribociclib
Cabazitaxel