Cabazitaxel (Intravenous)

Cabazitaxel, also known by the brand name Jevtana, is an intravenous chemotherapy treatment for those with prostate cancer.

Overview

Cabazitaxel is a medication used to treat those suffering from castrate-resistant metastatic prostate cancer that has been previously treated with a docetaxel-containing medication. It is used in combination with another drug called prednisone.

Prostate cancer occurs when cancerous tumors are formed in the prostate gland. They are caused by uncontrolled cell division. Normal and healthy tissue cells stop dividing when they meet other cells that are similar. Cancerous cells are not able to do this and so go on dividing, which becomes harmful to the body.

Chemotherapy treatment drugs such as Cabazitaxel work by preventing cell division. They do this by attacking the DNA that tells cells to divide, which then causes the cells to die. As the chemotherapy drug kills off the cancerous dividing cells, this shrinks the tumor. The drug is more effective in areas where the cells are dividing at a rapid rate.

Cabazitaxel will likely cause various side effects in patients. This is because chemotherapy drugs can not tell the difference between harmful dividing cells and healthy cells, so will attack them all in the same way. Cells that are most commonly attacked by drugs such as Cabazitaxel are those in the stomach, bowel, hair follicles and blood cells. Side effects that typically result from this are low blood counts, hair loss, nausea and vomiting, diarrhea and mouth sores. Patients taking chemotherapy drugs should be closely monitored at very regular intervals throughout the treatment.

Cabazitaxel, available under the brand name Jevtana, is part of a family of drugs called microtubule inhibitors. Protein that is present in Microtubules forms an essential part of the cell division process. Cabazitaxel works to stabilize that protein and prevent cell division. When division is prevented, the cells die.

Type of medicine

  • Supplied as a powder to make a liquid solution. Administered via the Intravenous (IV) route, into a vein

Conditions treated

  • Castrate-resistant metastatic prostate cancer

Side effects

As mentioned in the overview, chemotherapy drugs such as Cabazitaxel can cause some severe side effects and patients will need to take extra care in protecting themselves from these conditions becoming worse. A list of side effects is below. If you become worried about any of these side effects, you should always tell your doctor. Not everyone will experience all of the side effects below, but some are very common.

Often, the side effects of this drug can be manageable and controlled with other medication. The effects are often predictable in terms of their severity and length, and will usually stop as soon as the treatment is finished.

Side effects that occur in more than 30 percent of patients include:

  • Diarrhea
  • Fatigue and drowsiness
  • Nausea and vomiting
  • Stomach pain
  • Low blood counts, which puts patients at an increased risk of infection

Slightly less common side effects, typical in around 10 to 20 percent of patients, include:

  • Back pain
  • Loss of appetite
  • Tingling or numbness in the feet or hands
  • Shortness of breath and difficulty breathing
  • Fever
  • Joint aches
  • Hair loss
  • Persistent cough
  • Heartburn
  • Allergic reactions, such as low blood pressure, rash or hot flushing
  • Pain, swelling or darkening at the site of infusion

There are some side effects that require medical attention, although in most cases these are not considered emergencies. If you experience a high fever, excessive vomiting, consistent diarrhea, jaundice or change in frequency of urination, contact your doctor straight away for advice.

Major Interactions

There are some drugs that, if taken at the same time as this one, can cause reactions in the body. This is called a drug interaction and can result in various side effects, or prevent either drug from working properly. The drug combination could even make your medical conditions worse. There are 328 drugs that have some level of interaction with this medication, 31 of which are considered major reactions and should therefore be avoided at all times. The major drug interactions are:

  • adalimumab
  • bcg
  • certolizumab
  • clozapine
  • deferiprone
  • etanercept
  • fingolimod
  • golimumab
  • infliximab
  • influenza virus vaccine, h1n1, live
  • ¬†influenza virus vaccine, live, trivalent
  • leflunomide
  • measles virus vaccine
  • ¬†measles virus vaccine / mumps virus vaccine / rubella virus vaccine
  • measles virus vaccine / mumps virus vaccine / rubella virus vaccine / varicella virus vaccine
  • measles virus vaccine / rubella virus vaccine
  • mumps virus vaccine
  • mumps virus vaccine / rubella virus vaccine
  • natalizumab
  • poliovirus vaccine, live, trivalent
  • rotavirus vaccine
  • rubella virus vaccine
  • samarium sm 153 lexidronam
  • smallpox vaccine
  • talimogene laherparepvec
  • teriflunomide
  • tofacitinib
  • typhoid vaccine, live
  • varicella virus vaccine
  • yellow fever vaccine
  • zoster vaccine live

Dosage

The dosage given will depend on your medical history, your condition and any other medications you are taking. The drug will be issued with a dose of prednisone. The normal dose is 25 mg per square meter of body mass via injection into a vein.

Administration will be carried out by a doctor and will be repeated every three weeks. The infusion will take place over one hour for each administration.

This injection will be administered along with prednisone at a dosage of 10 mg per day every day throughout the course of treatment.

The dosage should be reduced to 20 mg per meter squared if there are certain side effects such as febrile neutropenia, persistent grade three diarrhea or grade two peripheral neuropathy. If the patient develops grade three peripheral neuropathy, the treatment should be discontinued.

Warnings

Disease interactions

There are also several diseases that interact with cabazitaxel and impact its ability to work. This medication may also make certain other conditions worse. Always tell your doctor if you are suffering from any other diseases or conditions and he or she will be able to advise on whether cabazitaxel is suitable and safe for you to take. These are the conditions that have a major reaction with this drug:

  • Infections
  • GI complications
  • Hepatic impairment
  • Hemodialysis
  • Pulmonary impairment
  • Myelosuppression
  • Renal failure

Neutropenia:

There have been some reports of death by neutropenia in those taking this medication. This is more likely to happen in patients with neutrophil counts of less than 1,500 cells / mm3. Doctors should monitor closely for signs of the patient developing neutropenia and discontinue the treatment if severe effects are found.

Severe hypersensitivity:

In rare cases, there have been reports of severe hypersensitivity in patients, which includes symptoms of rash, hypotension, and erythema. If the condition is detected, it will require urgent and immediate discontinuation of the treatment. Patients should then be prescribed medication to prevent the condition from worsening, and an alternative treatment for prostate cancer should be sought.

Infections:

Patients are at an increased risk of developing infections while taking this medication. This is due to the fact that it works by breaking down cells - both those that are cancerous and those that are healthy. A reduction in healthy blood cells can leave the immune system more vulnerable to contracting infections, and less effective at fighting them. Patients should take very careful precautions to help minimise the risk of contracting an infection, for example, staying away from other people with common colds or other ailments, staying indoors and keeping their environments sterile and clean at all times.

Allergies

Always tell your doctor if you are allergic to any of the ingredients in this medication. If you have had a severe allergic reaction to cabazitaxel in the past, you should not take it again, and there may be other chemotherapy drugs that are instead more suitable for you. Always ask your health care provider if you are unsure about using this medication, or if you think you experience allergic reactions to anything that could impact your suitability for taking cabazitaxel.

Conception:

If you are currently with a female partner, you should tell your doctor. You should not attempt to conceive with your partner while you are taking this medication, as the drug can cause harm to an unborn baby, and may result in loss of the pregnancy. You should also wait at least three months after your treatment of cabazitaxel has finished before you attempt to conceive. There is a chance that cabazitaxel may impact your fertility and make it more difficult for you to father a child. Another side effect that can impact your fertility is that you may find it more difficult to maintain an erection, and may also experience a loss of libido.

Elderly patients:

Elderly patients may be more vulnerable to fatal side effects or contracting fatal infections while taking this medication. Studies have found that those over the age of 65 have experienced increased toxicities while taking this drug. One trial found that two percent of those under 65 from a random sample of cabazitaxel had died from other causes during a 30-day treatment cycle. That number increased to six percent in those over the age of 65. Older patients may be more vulnerable to picking up infections as their bodies are less able to deal with the side effects of the drug, and their immune systems may be weaker. These patients should be monitored particularly closely and the treatment should be stopped as soon as any serious conditions are detected.

Women and children

This medication is only intended for treating those with prostate cancer, and therefore should not be used on female patients. It is also not known whether this medication results in any more severe side effects when administered to children. Prescribing this drug to children should, therefore, be approached with extreme caution, and smaller doses may be given to prevent side effects that would be too severe for a child's body to handle.

Storage

Cabazitaxel should be stored in its powder form at an ideal temperature of 25 degrees Celsius. This temperature can vary from between 15 to 30 degrees Celsius without the effectiveness of the medicine being altered.

Once the solution is diluted to form the injectable substance, it should be used immediately.

Any leftover solution should be disposed of immediately. Flush the solution away and do not let it come into contact with skin. Do not throw any leftover medicine away in regular trash - always dispose of medicines safely and responsibly.

Summary

Cabazitaxel is a very strong chemotherapy drug that is used to treat prostate cancer and shrink the size of growing tumors. Cabazitaxel has been found in numerous medical studies to not only prolong the life of patients with advanced prostate cancer but also to drastically improve the quality of life of those patients. There are various side effects that patients will commonly experience, but the health benefits the drug provides are usually far greater than the discomfort of the side effects.

Cabazitaxel is not a suitable treatment for everyone; there are a number of drugs, conditions and diseases that will interact with the drug, causing further side effects and, in some cases, impacting the effectiveness of the drug. Patients can help to decrease the risk of suffering from health problems caused by interactions by always telling their doctors the full extent of their medical history.

Patients that are taking this medication will be closely monitored by their health care professionals throughout the treatment cycle. During each one-hour sitting of the intravenous administration, tests will be taken to check how the body is responding to the drug, and how effective it is being in killing fast-dividing cancer cells. If the patient is found to be having severe side effects, or if the condition is not improving, the patient may be prescribed a different course of treatment.

If used according to the instructions, cabazitaxel can be a safe drug that can significantly prolong the lifespan of cancer sufferers when other treatments have failed to work and the disease has progressed past the point of castration.

Resources
Last Reviewed:
December 23, 2017
Last Updated:
April 04, 2018