Cabazitaxel (Jevtana®)

Cabazitaxel kills cancer cells by changing how the mictrotubules of cancer cells work. By targeting these microtubules, the cancer cells have a hard time growing and dividing.

How to Take Cabazitaxel

Cabazitaxel is given by intravenous (IV) infusion. The dose is based on your height and weight. Prior to each dose, you will be given medications, including an antihistamine (such as diphenhydramine), a corticosteroid (such as dexamethasone), and an H2 blocker (such as famotidine) to decrease the risk of an infusion reaction.

This medication can cause severe neutropenia (low white blood cell count). Your labs will be monitored weekly during the first cycle and then before the start of more cycles. If you are more at risk of becoming neutropenic (especially those over the age of 65), you may be given a medication that helps stimulate (rev up) the growth of new blood cells.

The blood levels of this medication can be affected by certain medications, so they should be avoided. These include: ketoconazole, itraconazole, posaconazole, voriconazole, clarithromycin, certain antiretroviral drugs used for HIV treatment, carbamazepine, phenytoin, phenobarbital, rifampin, and St. John’s wort. Be sure to tell your healthcare provider about all medications and supplements you take.

Possible Side Effects

There are a number of things you can do to manage the side effects of cabazitaxel. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:

Low White Blood Cell Count (Leukopenia or Neutropenia)

White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips to preventing infection:

• Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
• When working in your yard, wear protective clothing including long pants and gloves.
• Do not handle pet waste.
• Keep all cuts or scratches clean.
• Shower or bathe daily and perform frequent mouth care.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your oncology care team before scheduling dental appointments or procedures.
• Ask your oncology care team before you, or someone you live with has any vaccinations.

Allergic Reactions

In some cases, patients can have an allergic reaction to this medication. Signs of a reaction can include: shortness of breath or having a hard time breathing, chest pain, rash, flushing or itching, chest or throat tightness, swelling of the face, or feeling dizzy or faint. If you notice any changes in how you feel during the infusion, let your nurse know right away.

Low Red Blood Cell Count (Anemia)

Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your oncology care team know if you experience any shortness of breath, difficulty breathing, or pain in your chest. If the count gets too low, you may receive a blood transfusion.

Low Platelet Count (Thrombocytopenia)

Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. Let your oncology care team know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums or blood in your urine or stool. If the platelet count becomes too low, you may receive a transfusion of platelets.

• Do not use a razor (an electric razor is fine).
• Avoid contact sports and activities that can result in injury or bleeding.
• Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib) etc. as these can all increase the risk of bleeding. Please consult with your healthcare team regarding use of these agents and all over the counter medications/supplements while on therapy.
• Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.

Diarrhea

Your oncology care team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses of non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Diarrhea can be a serious side effect that can lead to dehydration. Notify your healthcare provider if you develop diarrhea.

Nausea and/or Vomiting

Talk to your oncology care team so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try saltines, or ginger ale to lessen symptoms.

Call your oncology care team if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Fatigue

Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.

Constipation

There are several things you can do to prevent or relieve constipation. Include fiber in your diet (fruits and vegetables), drink 8-10 glasses of non-alcoholic fluids a day, and keep active. A stool softener once or twice a day may prevent constipation. If you do not have a bowel movement for 2-3 days, you should contact your healthcare team for suggestions to relieve the constipation. This medication can cause a blockage in the bowel, so constipation should be taken seriously.

Important but Less Common Side Effects

• Gastrointestinal (GI) Bleed & Tear: This medication can cause bleeding or a tear in the intestinal (bowel) wall. Signs of these problems include: unexpected bleeding, blood in the stool or black stools, coughing up blood, vomiting blood, vomit that looks like coffee grounds, fever, severe pain in the abdomen, or new abdominal swelling. If you experience any of these, contact your healthcare provider immediately or go to the emergency room.
• Kidney Problems: This medication can cause kidney failure. Your kidney function will be monitored throughout treatment. If you experience swelling of your face or body, a decrease in the amount of urine you are producing, or if your urine appears darker in color or if there is blood in it, notify your healthcare team immediately.
• Lung Problems: This medication can cause respiratory disorders such as pneumonia, pneumonitis (inflammation), interstitial lung disease, and acute respiratory distress syndrome. If you develop any issues with breathing such as becoming short of breath, contact your care provider immediately.

Reproductive Concerns

This drug may affect your reproductive system, resulting in sperm production becoming irregular or stopping permanently. Exposure of an unborn child to this medication could cause birth defects, so you should not father a child while on this medication. Effective birth control is necessary during treatment and for 3 months after your last dose.