Chemotherapy drugs work against cancer by targeting and attacking cells that grow and divide quickly. However, other cells in the body that also rapidly grow and divide may be affected as a result. Among these are hair follicles, red blood cells in the bone marrow, and cells in the mouth and intestines.

Chemotherapy drugs are powerful and can take a physical toll on the body. Side effects are dependent on the drug type and dose a patient receives. They are usually temporary and will resolve after treatment. Drug reactions can vary from patient to patient, so it is important to pay attention to any side effects that you experience, expected or otherwise.

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What are the side effects?

In prostate cancer, docetaxel (Taxotere) and cabizatxel (Jevtana) are rather well tolerated by patients.  Some patients have reported that their disease-related symptoms (ie: pain and fatigue) improved after receiving  chemotherapy.  

It is important to understand that the use of chemotherapy in cancer does have an impact on the body.  Side effects from all treatments are not the same for each person and they may be dependent on many factors including type of chemotherapy, amount of the medication given and the health of the patient. It is critical that patients pay attention to their bodies and share the side effects they are experiencing as well as the severity of the side effects with their physicians.  There are many ways to help reduce the side effects and improve tolerability of this life-saving treatment option.

  • Approximately 50% of men will experience significant fatigue at some point during chemotherapy.  This often happens during the first week of each cycle.
  • Between 5-10% of men experience a fever with a low white blood cell count that will require medical attention.  This could be life threatening and patients should be counseled by physicians to report any fevers while receiving chemotherapy.
  • About 33% of men receiving docetaxel experience numbness or weakness in their fingers or toes that interferes with daily functions. This side effect could be permanent but is many cases it improves over time. There are many studies underway to look at reducing the risk of numbness and weakness (neuropathy) from chemotherapy so be sure to talk to your doctor about the most current information.
  • Mild side effects from chemotherapy may include nail changes (30%), shortness of breath (15%), fluid retention (10-20%), reduced heart function (10%), anemia (5%), or low platelets resulting in bleeding (1%). Most of these are mild, reversible, treatable, and should not be a reason to avoid chemotherapy.

Common side effects include:

o    Fatigue
o    Nausea / decreased appetite (occurring in 20% of patients)
o    Mouth sores
o    Diarrhea (32%)
o    Hair loss (65%)
o    Low white blood cell count
o    Increased risk of infection
o    Weakness/numbness in fingers and toes

With docetaxel, about 1/3 of men will experience numbness or weakness in their fingers or toes that may interfere with function (called neuropathy). This side effect is not always reversible, but in most cases, resolves slowly over time. There are no treatments to prevent neuropathy, but reducing the dose of docetaxel, delaying the next dose, or stopping treatment can slow neuropathy and potentially prevent its progression. If you are developing neuropathy, talk with your doctor about how to best handle future cycles of docetaxel.

Additional side effects of docetaxel may include: nail changes (30%), shortness of breath (15%), fluid retention (10-20%), reduced heart function (10%), anemia (5%), or low platelets resulting in bleeding (1%). Most of these are mild, reversible, treatable, and should not be a reason to avoid chemotherapy if medically indicated.


For patients taking Cabazitaxel (Jevtana), the following side effects are common (occurring in more than 30% of patients):

o    Fatigue (37%)
o    Low blood counts -- your white blood cells, red blood cells, and platelets may temporarily decrease. This can put you at increased risk for infection, anemia and/or bleeding.
o    Diarrhea
o    Nausea

The following side effects are less common (occurring in 10-29%):

o    Abdominal pain (17%)
o    Peripheral neuropathy (numbness/tingling of the hands and/or feet) (13%)
o    Shortness of breath (12%)
o    Hair Loss (10%)
o    Headache (8%)
o    Low blood pressure (5%)
o    Vomiting
o    Constipation
o    Weakness
o    Blood in urine
o    Lack of appetite
o    Back pain
o    Fever
o    Changes in taste
o    Joint aches
o    Cough
o    Heartburn

Cabazitaxel is a type of chemotherapy, which does affect blood counts. It is almost always given with the supportive medication to boost infection-fighting white blood cells and should be closely monitored by doctors.

Recent data suggests that when cabazitaxel is given at a lower dose than was initially approved by the FDA, the side effects may be reduced, but the life-saving impact is not impacted.

Infusion-related side effects are symptoms that may occur while the drug is going into the vein. These include both allergic and infusion site reactions.
o    Infusion site reactions: darkening or swelling of the vein, skin redness, pain.
o    Symptoms of an allergic reaction may include rash, flushing, fever, lowered blood pressure.
o    Allergic reactions are rare and usually occur during the first or second infusion. Pre-medication reduces the frequency of this reaction. You will be closely monitored throughout the infusion for any signs of allergic reaction.

Important things to remember about the side effects:

o    Most people will not experience all of the side effects listed.
o    Side effects are often predictable in terms of their onset, duration, and severity.
o    Side effects are often reversible and are likely to improve after therapy is complete.
o    There are many options to help minimize or prevent side effects.
o    There is no relationship between the presence or severity of side effects and the efficacy of the chemotherapy medication.
o    Not all side effects are listed above. Very rare side effects -- those occurring in less than 10% of patients -- are not listed here. You should always inform your healthcare provider if you experience any unusual symptoms.

Regardless of the type of chemotherapy you are receiving, it is important to ensure that all of your side effects are being addressed immediately and options for side effect management are part of your discussions with your doctors.

When to contact your doctor or health care provider:

Contact your healthcare provider immediately, day or night, if you should experience any of the following symptoms:

o    Fever of 100.4° F (38° C) or higher
o    Chills (possible signs of infection)

The following symptoms require medical attention but are not an emergency. Contact your healthcare provider within 24 hours of noticing any of the following:
o    Nausea (that interferes with ability to eat and unrelieved with prescribed medication)
o    Vomiting (more than 4-5 times in a 24-hour period)
o    Diarrhea (4-6 episodes in a 24-hour period)
o    Unusual bleeding or bruising
o    Black or tarry stools, or blood in your stools
o    Extreme fatigue (unable to carry on self-care activities)
o    Yellowing of the skin or eyes
o    Shortness of breath
o    Significant changes in urination (decreased amounts of urine output)
o    Always inform your healthcare provider if you experience any unusual symptoms.

Precautions:

Before starting treatment, make sure you tell your provider about any other medications or supplements you are taking (prescription, over the counter, vitamins, herbal remedies, etc.).
o    Do not take aspirin or products containing aspirin unless your doctor specifically allows this.
o    Refrain from taking St. John's Wort.
o    Avoid drinking grapefruit juice or eating grapefruit. 
o    While taking cabazitaxel, do not receive any kind of immunization or vaccination without your doctor's approval.
o    For both men and women -- Use contraceptives and do not conceive a child (get pregnant) while taking cabazitaxel. Barrier methods of contraception, such as condoms, are recommended.


Monitoring and Testing

While you are taking cabazitaxel, you will be regularly checked to monitor side effects and your response to therapy. Your healthcare provider will order periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs such as your kidneys and liver.

 

Resources:

The role of cabazitaxel in the treatment of metastatic castration-resistant prostate cancer
Che-Kai Tsao , Elena Cutting, Jacob Martin, William K. Oh
Ther Adv Urol. 2014 Jun; 6(3): 97--104.  doi: 10.1177/1756287214528557

Quality of life and emotional distress in advanced prostate cancer survivors undergoing chemotherapy
Peter C Trask
Health Qual Life Outcomes. 2004; 2: 37.  Published online 2004 Jul 23. doi: 10.1186/1477-7525-2-37

Prostate Cancer Foundation Patient Guide 12.19.19

“For the first month or two, I continued to swim, though not as much as I had been. I assumed that if I stayed active it would help me through the chemo. I was never incapacitated in that sense. There were a few days where either I didn’t feel well or was really tired, so I didn’t go out and pound the pavement or anything.”

Prostatepedia Interview 8/28/18