Chemotherapy regimens for recurrent head and neck cancer: Weekly single-agent docetaxel^[1]

Cycle length: 7 days. Duration of therapy: Weekly, until disease progression or unacceptable toxicity.*
Drug	Dose and route	Administration	Given on days
Docetaxel	40 mg/m² IV	Dilute in 100 or 250 mL NS^¶ to a final concentration of 0.3 to 0.74 mg/mL and administer over 60 minutes.	Day 1
Pretreatment considerations:
Emesis risk	LOW. Refer to UpToDate topics on prevention of chemotherapy-induced nausea and vomiting in adults.
Prophylaxis for infusion reactions and fluid retention	Premedication with dexamethasone prior to docetaxel administration is recommended, but the dose and schedule are variable.^Δ Refer to UpToDate topics on infusion reactions to systemic chemotherapy.
Vesicant/irritant properties	Docetaxel is an irritant but can cause significant tissue damage; avoid extravasation. Refer to UpToDate topics on extravasation injury from chemotherapy and other non-antineoplastic vesicants.
Infection prophylaxis	Primary prophylaxis with G-CSF is not indicated (incidence of neutropenic fever is approximately 5%).^[1] Refer to UpToDate topics on use of granulocyte colony stimulating factors in adult patients with chemotherapy-induced neutropenia and conditions other than acute leukemia, myelodysplastic syndrome, and hematopoietic cell transplantation.
Dose adjustment for baseline liver or renal dysfunction	Docetaxel should not be administered to patients with a serum bilirubin above the ULN (except due to Gilbert syndrome) or to patients with transaminase elevations >1.5 × ULN in conjunction with alkaline phosphatase >2.5 × ULN.^[3] Refer to UpToDate topics on chemotherapy hepatotoxicity and dose modification in patients with liver disease and gilbert syndrome and unconjugated hyperbilirubinemia due to bilirubin overproduction.
Dose adjustment for known drug interactions	Caution is needed when administering docetaxel with strong CYP3A4 inhibitors. Although specific dose recommendations are not available, the United States Prescribing Information suggests close monitoring for toxicity and consideration of docetaxel dose reduction if coadministration with a strong CYP3A4 inhibitor cannot be avoided.^[3] Refer to UpToDate graphic "Cytochrome P450 3A (including 3A4) inhibitors and inducers".
Monitoring parameters:
Assess CBC with differential and platelet count prior to treatment weekly.
Assess basic metabolic panel including creatinine and electrolytes, and liver function tests prior to treatment weekly.
Monitor for neurotoxicity, diarrhea, fluid retention, muscle weakness, and skin and/or nail changes prior to treatment weekly. Refer to UpToDate topics on overview of neurologic complications of conventional non-platinum cancer chemotherapy, taxane-induced pulmonary toxicity, and cutaneous side effects of conventional chemotherapy agents.
Suggested dose modifications for toxicity:
Myelotoxicity	Patients should not be treated with weekly docetaxel unless neutrophils ≥2000/microL and platelets ≥75,000/microL.^[2] Reduce docetaxel dose by 25% for subsequent doses >8 days to recover from myelosuppression or if neutropenic fever occurs.^[2]
Hepatotoxicity	Docetaxel dose reduction may be needed for patients who develop significant alterations in transaminases and alkaline phosphatase during therapy. Docetaxel should not be administered to patients with a serum bilirubin above the ULN or to patients with transaminase elevations >1.5 × ULN in conjunction with alkaline phosphatase >2.5 × ULN. Refer to UpToDate topics on chemotherapy hepatotoxicity and dose modification in patients with liver disease.
Other toxicity	If any other grade 3 or 4 toxicity occurs (other than alopecia, nausea, or vomiting) hold docetaxel until the toxicity resolves to <grade 2, and then reduce docetaxel dose by 25% for subsequent doses.^[2]
If there is a change in body weight of at least 10%, doses should be recalculated.

This table is provided as an example of how to administer this regimen; there may be other acceptable methods. This regimen must be administered by a clinician trained in the use of chemotherapy, who should use independent medical judgment in the context of individual circumstances to make adjustments, as necessary.

IV: intravenous; NS: normal saline; G-CSF: granulocyte colony stimulating factors; ULN: upper limit of normal; CYP3A4: cytochrome P450 3A4; CBC: complete blood count.

* The original protocol mandated radiographic assessments every 6 weeks.

¶ Diluent solutions should not be modified without consulting a detailed reference due to potential incompatibility(ies).

Δ For patients who receive docetaxel every 3 weeks, premedication with dexamethasone (8 mg orally twice a day for 3 consecutive days) is typically started 24 hours before chemotherapy. However, patients who receive docetaxel on a weekly dosing have the potential to receive substantial doses of dexamethasone with this approach. An alternative method is to administer dexamethasone 8 mg orally twice a day for 24 hours prior to docetaxel infusion for the first 2 weekly chemotherapy doses, with a switch to a single dose of dexamethasone at 8 mg prior to each weekly dose of docetaxel if there is no reaction after the first 2 weekly chemotherapy doses.^[4]

References:

Guardiola E, et al. Eur J Cancer 2004; 40: 2071.
Hainsworth JD, et al. J Clin Oncol 1998; 16: 2164.
Docetaxel injection. United States Prescribing Information. US National Library of Medicine. (Available online at www.dailymed.nlm.nih.gov, accessed September 15, 2021).
Sparano JA, et al. N Engl J Med 2008; 358:1663.

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Chemotherapy regimens for recurrent head and neck cancer: Weekly single-agent docetaxel[1]

Chemotherapy regimens for recurrent head and neck cancer: Weekly single-agent docetaxel^[1]