Taxanes

Question 1

What drugs are in the Taxanes class?

Answer 1

Drugs in this class are:
- Docetaxel
- Cabazitaxel
- Paclitaxel
- NabPaclitaxel

Question 2

What is the brand name of Docetaxel?

Answer 2

The brand name of this generic drug is:
- Taxotere

Question 3

What is the brand name of Cabazitaxel?

Answer 3

The brand name of this generic drug is:
- Jevtana

Question 4

What is the brand name of Paclitaxel?

Answer 4

The brand name of this generic drug is:
- Taxol

Question 5

What is the brand name of NabPaclitaxel?

Answer 5

The brand name of this generic drug is:
- Abraxane

Question 6

What is the generic of name of Taxotere?

Answer 6

The generic name of this brand name drug is:
- Docetaxel

Question 7

What is the generic of name of Jevtana?

Answer 7

The generic name of this brand name drug is:
- Cabazitaxel

Question 8

What is the generic of name of Taxol?

Answer 8

The generic name of this brand name drug is:
- Paclitaxel

Question 9

What is the generic of name of Abraxane?

Answer 9

The generic name of this brand name drug is:
- NabPaclitaxel

Question 10

What are the main indications for use of Docetaxel?

Answer 10

The main indications of this drug are:
- Breast Cancer
- Esophageal Cancer
- Gastric Cancer
- Head and Neck Cancer
- Non-Small Cell Lung Cancer
- Ovarian Cancer
- Prostate Cancer
- Small Cell Lung Cancer

Question 11

What are the main indications for use of Paclitaxel?

Answer 11

The main indications of this drug are:
- Breast Cancer
- Esophageal Cancer
- Gastric Cancer
- Head and Neck Cancer
- Non-Small Cell Lung Cancer
- Ovarian Cancer
- Small Cell Lung Cancer
- Anal Cancer
- Bladder Cancer
- Cervical Cancer
- Endometrial Cancer
- Kaposi Sarcoma

Question 12

What are the main indications for use of NabPaclitaxel?

Answer 12

The main indications of this drug are:
- Breast Cancer
- Non-Small Cell Lung Cancer
- Ovarian Cancer
- Bladder Cancer
- Cervical Cancer
- Biliary Cancer
- Pancreatic Cancer

Question 13

What is the class and MOA of Docetaxel?

Answer 13

This drug in the following class:
- Taxanes

This drug’s MOA is as follows:
- Taxanes inhibit the mitotic spindle.
- They bind to tubulin and prevent microtubule depolymerization - therefore inhibiting mitosis and inducing apoptosis in cells undergoing the division process.
- These drugs are cell-cycle specific in the M-phase.

Question 14

What is the class and MOA of Cabazitaxel?

Answer 14

This drug in the following class:
- Taxanes

This drug’s MOA is as follows:
- Taxanes inhibit the mitotic spindle.
- They bind to tubulin and prevent microtubule depolymerization - therefore inhibiting mitosis and inducing apoptosis in cells undergoing the division process.
- These drugs are cell-cycle specific in the M-phase
- Unlike other taxanes, this drug has a poor affinity for multidrug resistance (MDR) proteins, therefore conferring activity in resistant tumors.

Question 15

What is the class and MOA of Paclitaxel?

Answer 15

This drug in the following class:
- Taxanes

This drug’s MOA is as follows:
- Taxanes inhibit the mitotic spindle.
- They bind to tubulin and prevent microtubule depolymerization - therefore inhibiting mitosis and inducing apoptosis in cells undergoing the division process.
- These drugs are cell-cycle specific in the M-phase.

Question 16

What is the class and MOA of NabPaclitaxel?

Answer 16

This drug in the following class:
- Taxanes

This drug’s MOA is as follows:
- Taxanes inhibit the mitotic spindle.
- They bind to tubulin and prevent microtubule depolymerization - therefore inhibiting mitosis and inducing apoptosis in cells undergoing the division process.
- These drugs are cell-cycle specific in the M-phase.

Question 17

Describe the emetic potential of the Taxanes class.

Answer 17

The emetic potential of this drug class is:
- Low (all agents)

Question 18

Describe the extravasation risk and management strategies for Paclitaxel.

Answer 18

The extravasation risk and management strategies for this drug are as follows:
- Irritant with vesicant-like properties
- Consider the use of hyaluronidase - Administer 1 to 6 ml (150 units/ml) into existing IV line: usual dose is 1 ml for each 1 ml of extravasated drug.

Question 19

Describe the extravasation risk and management strategies for Docetaxel.

Answer 19

The extravasation risk and management strategies for this drug are as follows:
- Irritant with vesicant-like properties

Question 20

Describe the extravasation risk and management strategies for the Taxanes class.

Answer 20

The extravasation risk and management strategies for this drug class are as follows:
- Paclitaxel and Docetaxel are irritants with vesicant-like properties
- NabPaclitaxel may be an irritant

Question 21

Describe the administration of Docetaxel.

Answer 21

The administration of this drug is described as follows:
- Use Low-sorb tubing BUT NO IN-LINE FILTER

Question 22

Describe the administration of Cabazitaxel.

Answer 22

The administration of this drug is described as follows:
- Use Low-sorb tubing with an in-line filter

Question 23

Describe the administration of Paclitaxel.

Answer 23

The administration of this drug is described as follows:
- Use Low-sorb tubing with an in-line filter

Question 24

Describe the general techniques for administration of the Taxanes class.

Answer 24

The general techniques for administration of this drug class is described as follows:
- Paclitaxel and Cabazitaxel require low-sorb tubing and in-line filter
- Docetaxel requires low-sorb tubing BUT NO IN-LINE FILTER

Question 25

Describe the metabolism of Docetaxel.

Answer 25

The metabolism of this drug is as follows:
- Primarily hepatic metabolism by CYP3A4 (CYP2C8 minor).
- Dose adjustments are recommended in patients with hepatic impairment.

Question 26

Describe the metabolism of Cabazitaxel.

Answer 26

The metabolism of this drug is as follows:
- Primarily hepatic metabolism by CYP3A4/3A5 (CYP2C8 minor).
- Dose adjustments are recommended in patients with hepatic impairment.

Question 27

Describe the metabolism of Paclitaxel.

Answer 27

The metabolism of this drug is as follows:
- Primarily hepatic metabolism by CYP2C8 (CYP3A4 minor).
- Dose adjustments are recommended in patients with hepatic impairment.

Question 28

Describe the metabolism of NabPaclitaxel.

Answer 28

The metabolism of this drug is as follows:
- Primarily hepatic metabolism by CYP2C8 (CYP3A4 minor).
- Dose adjustments are recommended in patients with hepatic impairment.

Question 29

What are the notable ADRs of Paclitaxel?

Answer 29

The notable ADRs of this drug are:
- Infusion reactions

Question 30

What are the notable ADRs of Docetaxel?

Answer 30

The notable ADRs of this drug are:
- Peripheral edema (black box warning)

Question 31

Describe the strategy and rationale for management of infusion reactions caused by Paclitaxel.

Answer 31

The strategy and rationale for management of this condition caused by this drug are:
- This drug has poor water solubility and is thus formulated with a polyethoxylated castor oil (Cremophor).
- This viscous solution is likely to cause hypersensitivity reactions, but these reactions are due to the Cremophor (not the drug itself).
- In order to prevent these reactions, patients should be premedicated with antihistamines and corticosteroids. Typically, patients receive dexamethasone 10-20 mg oral 12 and 6 hours prior to the infusion, plus diphenhydramine 50 mg IV and ranitidine 50 mg IV 30 minutes prior to the infusion.

Question 32

Describe the strategy and rationale for management of peripheral edema caused by Docetaxel.

Answer 32

The strategy and rationale for management of this condition caused by this drug are:
- Characterized by pleural effusions (requiring immediate drainage), ascites with pronounced abdominal distention, peripheral edema, dyspnea at rest, cardiac tamponade, and/or generalized edema.
- Premedication with corticosteroids for 3 days, beginning the day before drug administration, is recommended to prevent pulmonary/peripheral edema.
- Patients typically receive dexamethasone 8mg oral twice daily 1 day prior to drug and continuing for 2 days after.

Question 33

What are the clinical pearls of NabPaclitaxel?

Answer 33

The clinical pearls of this drug are as follows:
- Not interchangeable with other paclitaxel formulations and cannot be substituted for conventional paclitaxel.

Question 34

What is the history of the Taxanes class?

Answer 34

The history of this drug class is as follows:
- Discovered in 1971 by NCI researchers during a plant screening program when a crude extract with anti-tumor activity was isolated from the bark of the Pacific Yew, Taxus brevifolia.
- But the amount of paclitaxel in yew bark was small and extracting it was complicated and expensive and the collection of Pacific Yew bark also became restricted for environmental reasons.
- This led to production of semi-synthetic form of paclitaxel derived from the needles of the Himalayan yew tree, Taxus bacatta.

Question 35

What drug(s) of the Taxanes class is notable for causing Peripheral Edema?

Answer 35

The drugs in this class notable for cause this condition are:
- Docetaxel

Question 36

What drug(s) of the Taxanes class is notable for causing Infusion Reactions?

Answer 36

The drugs in this class notable for cause this condition are:
- Paclitaxel (due to Cremophor)