Docetaxel and liver dysfunction

Q: Docetaxel should be used with high caution in? (select one)

A) Liver insufficiency

B) Kidney insufficiency

Answer: A

Docetaxel is a popular anti-cancer agent, but it should be used with caution in patients whose bilirubin is above the Upper Limit of Normal (ULN), AST, and/or ALT >1.5 times the ULN concomitant with alkaline phosphatase >2.5 times the ULN.

Patients with elevations of bilirubin or abnormalities of transaminase concurrent with alkaline phosphatase are at increased risk for development of severe neutropenia, febrile neutropenia, infections, severe thrombocytopenia, severe stomatitis, severe skin toxicity, and toxic death. Moreover, patients with isolated transaminase elevations>1.5 times the ULN also had a higher rate of febrile neutropenia. 

Bilirubin, AST, ALT, and alkaline phosphatase should be measured prior to each cycle of docetaxel therapy.

#oncology

#pharmacology

References:

1. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Docetaxel. [Updated 2020 Oct 13]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548899/

2. Koukourakis MI, Kapsoritakis A, Maltezos E, Potamiano S, Mouzas I, Kouroumalis H. Unexpected toxicity after low-dose docetaxel treatment of a cancer patient with clinically latent HCV-positive hepatic cirrhosis. Anticancer Res. 2002 Jul-Aug;22(4):2491-2. PMID: 12174950.

3. Samur M. Docetaxel and liver dysfunction: is it absolutely contraindicated? Am J Clin Oncol. 2001 Jun;24(3):319-20. doi: 10.1097/00000421-200106000-00024. PMID: 11404510.