post-title portfolio-title Docetaxel Injection IP 20mg/0.5ml (Apidryl) Taj Pharma 2020-02-13 06:57:58 no no

Docetaxel Injection IP 20mg/0.5ml (Apidryl) Taj Pharma

Overview

INTRODUCTION OF APIDRYL INJECTION

Apidryl 40 mg Injection is an anti-cancer medication used for the treatment of breast cancer, non-small cell lung cancer, prostate cancer and cancers of head and neck.

It is given as an injection by a qualified medical professional. It prevents cancer cells to divide and multiply. This slows the growth of cancer cells and eventually kills them. You should continue to take Apidryl 40 mg Injection as long as your doctor advises you. The duration of treatment varies with the type of cancer you have and other factors like your response to treatment. Your doctor may get regular blood tests done to monitor your blood cells and liver function during treatment with this medicine. In the case of white blood cell disturbances, Some people may experience associated fever or infections.

It may cause side effects such as swelling of hands, lips, hair loss, and weight gain. To reduce these side effects your doctor may suggest some medication along with it. But, inform your doctor if you notice unexplained bruising or bleeding, sore throat, mouth ulcers, high temperature (fever). You should not take it if you are pregnant or breastfeeding. It is better to use reliable methods of contraception to prevent pregnancy while taking this medicine.

USES OF APIDRYL INJECTION

  • Breast cancer
  • Non-small cell lung cancer
  • Prostate cancer
  • Cancer of head and neck

APIDRYL INJECTION SIDE EFFECTS

Common
  • Infection
  • Decreased blood cell count
  • Loss of appetite
  • Muscle pain
  • Fluid retention
  • Weakness
  • Constipation
  • Nail disorder
  • Shortness of breath
  • Pain

HOW TO USE APIDRYL INJECTION

Your doctor or nurse will give you this medicine. Kindly do not self administer.

HOW APIDRYL INJECTION WORKS

Apidryl 40 mg Injection is an anticancer medication. It works by interfering with the microtubule structures which help the cancer cells to divide and multiply. This slows the growth of cancer cells and eventually kills them.

APIDRYL INJECTION RELATED WARNINGS

warnings

Alcohol

UNSAFE
It is unsafe to consume alcohol with Apidryl 40 mg Injection
warnings

Pregnancy

CONSULT YOUR DOCTOR
Apidryl 40 mg Injection is unsafe to use during pregnancy as there is definite evidence of risk to the developing baby. However, the doctor may rarely prescribe it in some life-threatening situations if the benefits are more than the potential risks. Please consult your doctor.
warnings

Lactation

UNSAFE
Apidryl 40 mg Injection is unsafe to use during breastfeeding. Data suggests that the drug may cause toxicity to the baby.
warnings

Driving

CONSULT YOUR DOCTOR
It is not known whether Apidryl 40 mg Injection alters the ability to drive. Do not drive if you experience any symptoms that affect your ability to concentrate and react.
warnings

Kidney

SAFE IF PRESCRIBED
Apidryl 40 mg Injection is safe to use in patients with kidney disease. No dose adjustment of Apidryl 40 mg Injection is recommended.
warnings

Liver

CAUTION
Apidryl 40 mg Injection should be used with caution in patients with liver disease. Dose adjustment of Apidryl 40 mg Injection may be needed. Please consult your doctor.

 

Docetaxel 20mg/0.5ml concentrate for solution for infusion (Apidryl) Taj Pharma

1. Name of the medicinal product
a) Docetaxel 20mg/0.5ml concentrate for solution for infusion (Apidryl) Taj Pharma

b) Docetaxel 80mg/2ml concentrate for solution for infusion (Apidryl) Taj Pharma
c) Docetaxel 120mg/3ml concentrate for solution for infusion (Apidryl) Taj Pharma

2. Qualitative and quantitative composition
(a) One vial of 0.5ml of concentrate contains 20mg of docetaxel.

Each ml of concentrate contains 40mg docetaxel anhydrous.

(b) One vial of 2ml of concentrate contains 80mg of docetaxel.
Each ml of concentrate contains 40mg docetaxel anhydrous.

(c) One vial of 3ml of concentrate contains 120mg of docetaxel.
Each ml of concentrate contains 40mg docetaxel anhydrous.

3. Pharmaceutical form
Concentrate for solution for infusion.
The concentrate is a clear viscous, colourless to brownish-yellow sterile solution.

4. Clinical particulars

4.1 Therapeutic indications
Breast cancer

Docetaxel in combination with doxorubicin and cyclophosphamide is indicated for the adjuvant treatment of patients with:

  • operable node- positive breast cancer.
  • operable node- negative breast cancer.

For patients with operable node-negative breast cancer, adjuvant treatment should be restricted to patients eligible to receive chemotherapy according to internationally established criteria for primary therapy of early breast cancer (see section 5.1).

Docetaxel in combination with doxorubicin is indicated for the treatment of patients with locally advanced or metastatic breast cancer who have not previously received cytotoxic therapy for this condition.

Docetaxel monotherapy is indicated for the treatment of patients with locally advanced or metastatic breast cancer after failure of cytotoxic therapy. Previous chemotherapy should have included an anthracycline or an alkylating agent.

Docetaxel in combination with trastuzumab is indicated for the treatment of patients with metastatic breast cancer whose tumours over express HER2 and who previously have not received chemotherapy for metastatic disease.

Docetaxel in combination with capecitabine is indicated for the treatment of patients with locally advanced or metastatic breast cancer after failure of cytotoxic chemotherapy. Previous therapy should have included an anthracycline.

Non-small cell lung cancer
Docetaxel is indicated for the treatment of patients with locally advanced or metastatic non-small cell lung cancer after failure of prior chemotherapy.

Docetaxel in combination with cisplatin is indicated for the treatment of patients with unresectable, locally advanced or metastatic non-small cell lung cancer, in patients who have not previously received chemotherapy for this condition.

Prostate cancer
Docetaxel in combination with prednisone or prednisolone is indicated for the treatment of patients with hormone refractory metastatic prostate cancer.

Gastric adenocarcinoma
Docetaxel in combination with cisplatin and 5 fluorouracil is indicated for the treatment of patients with metastatic gastric adenocarcinoma, including adenocarcinoma of the gastroesophageal junction, who have not received prior chemotherapy for metastatic disease.

Head and neck cancer
Docetaxel in combination with cisplatin and 5 fluorouracil is indicated for the induction treatment of patients with locally advanced squamous cell carcinoma of the head and neck.

4.2 Posology and method of administration
The use of docetaxel should be confined to units specialised in the administration of cytotoxic chemotherapy and it should only be administered under the supervision of a physician qualified in the use of anticancer chemotherapy (see section 6.6).

Recommended dose
For breast, non-small cell lung, gastric, and head and neck cancers, premedication consisting of an oral corticosteroid, such as dexamethasone 16 mg per day (e.g. 8 mg BID) for 3 days starting 1 day prior to docetaxel administration, unless contraindicated, can be used (see section 4.4). Prophylactic G CSF may be used to mitigate the risk of haematological toxicities.

For prostate cancer, given the concurrent use of prednisone or prednisolone the recommended premedication regimen is oral dexamethasone 8 mg, 12 hours, 3 hours and 1 hour before the docetaxel infusion (see section 4.4).

Docetaxel is administered as a one-hour infusion every three weeks.

Breast cancer
In the adjuvant treatment of operable node-positive and node-negative breast cancer, the recommended dose of docetaxel is 75 mg/m2?administered 1 hour after doxorubicin 50 mg/m2?and cyclophosphamide 500 mg/m2?every 3 weeks for 6 cycles (TAC regimen) (see also Dose adjustments during treatment).

For the treatment of patients with locally advanced or metastatic breast cancer, the recommended dose of docetaxel is 100 mg/m2?in monotherapy. In first-line treatment, docetaxel 75 mg/m2?is given in combination therapy with doxorubicin (50 mg/m2).

In combination with trastuzumab the recommended dose of docetaxel is 100 mg/m2?every three weeks, with trastuzumab administered weekly. In the pivotal study the initial docetaxel infusion was started the day following the first dose of trastuzumab. The subsequent docetaxel doses were administered immediately after completion of the trastuzumab infusion, if the preceding dose of trastuzumab was well tolerated. For trastuzumab dose and administration, see trastuzumab summary of product characteristics.

In combination with capecitabine, the recommended dose of docetaxel is 75 mg/m2?every three weeks, combined with capecitabine at 1250 mg/m2?twice daily (within 30 minutes after a meal) for 2 weeks followed by a 1 week rest period. For capecitabine dose calculation according to body surface area, see capecitabine summary of product characteristics.

Non-small cell lung cancer
In chemotherapy na?ve patients treated for non-small cell lung cancer, the recommended dose regimen is docetaxel 75 mg/m2?immediately followed by cisplatin 75 mg/m2?over 30-60 minutes. For treatment after failure of prior platinum-based chemotherapy, the recommended dose is 75 mg/m? as a single agent.

Prostate cancer
The recommended dose of docetaxel is 75 mg/m2. Prednisone or prednisolone 5 mg orally twice daily is administered continuously (see section 5.1).

Gastric adenocarcinoma
The recommended dose of docetaxel is 75 mg/m2 as a 1-hour infusion, followed by cisplatin 75 mg/m2, as a 1- to 3-hour infusion (both on day 1 only), followed by 5 fluorouracil 750 mg/m2?per day given as a 24 hour continuous infusion for 5 days, starting at the end of the cisplatin infusion. Treatment is repeated every three weeks. Patients must receive premedication with antiemetics and appropriate hydration for cisplatin administration. Prophylactic G CSF should be used to mitigate the risk of haematological toxicities (see also Dose adjustments during treatment).

Head and neck cancer
Patients must receive premedication with antiemetics and appropriate hydration (prior to and after cisplatin administration). Prophylactic G CSF may be used to mitigate the risk of haematological toxicities. All patients on the docetaxel-containing arm of the TAX 323 and TAX 324 studies, received prophylactic antibiotics.

  • Induction chemotherapy followed by radiotherapy (TAX 323)

For the induction treatment of inoperable locally advanced squamous cell carcinoma of the head and neck (SCCHN), the recommended dose of docetaxel is 75 mg/m2?as a 1 hour infusion followed by cisplatin 75 mg/m2?over 1 hour, on day one, followed by 5 fluorouracil as a continuous infusion at 750 mg/m2?per day for five days. This regimen is administered every 3 weeks for 4 cycles. Following chemotherapy, patients should receive radiotherapy.

  • Induction chemotherapy followed by chemoradiotherapy (TAX 324)

For the induction treatment of patients with locally advanced (technically unresectable, low probability of surgical cure, and aiming at organ preservation) squamous cell carcinoma of the head and neck (SCCHN), the recommended dose of docetaxel is 75 mg/m2?as a 1 hour intravenous infusion on day 1, followed by cisplatin 100 mg/m2?administered as a 30-minute to 3-hour infusion, followed by 5-fluorouracil 1000 mg/m2/day as a continuous infusion from day 1 to day 4. This regimen is administered every 3 weeks for 3 cycles. Following chemotherapy, patients should receive chemoradiotherapy.

For cisplatin and 5 fluorouracil dose modifications, see the corresponding summary of product characteristics.

Dose adjustments during treatment

General
Docetaxel should be administered when the neutrophil count is ? 1,500 cells/mm3.

In patients who experienced either febrile neutropenia, neutrophil count < 500 cells/mm3?for more than one week, severe or cumulative cutaneous reactions or severe peripheral neuropathy during docetaxel therapy, the dose of docetaxel should be reduced from 100 mg/m2?to 75 mg/m2?and/or from 75 to 60 mg/m?. If the patient continues to experience these reactions at 60 mg/m?, the treatment should be discontinued.

Adjuvant therapy for breast cancer
Primary G-CSF prophylaxis should be considered in patients who receive docetaxel, doxorubicin and cyclophosphamide (TAC) adjuvant therapy for breast cancer. Patients who experience febrile neutropenia and/or neutropenic infection should have their docetaxel dose reduced to 60 mg/m2 in all subsequent cycles (see sections 4.4 and 4.8). Patients who experience Grade 3 or 4 stomatitis should have their dose decreased to 60 mg/m2.

In combination with cisplatin
For patients who are dosed initially at docetaxel 75 mg/m2?in combination with cisplatin and whose nadir of platelet count during the previous course of therapy is < 25,000 cells/mm3, or in patients who experience febrile neutropenia, or in patients with serious non-haematologic toxicities, the docetaxel dose in subsequent cycles should be reduced to 65 mg/m2. For cisplatin dose adjustments, see the corresponding summary of product characteristics.

In combination with capecitabine

  • For capecitabine dose modifications, see capecitabine summary of product characteristics.
  • For patients developing the first appearance of Grade 2 toxicity, which persists at the time of the next docetaxel/capecitabine treatment, delay treatment until resolved to Grade 0-1, and resume at 100% of the original dose.
  • For patients developing the second appearance of Grade 2 toxicity, or the first appearance of Grade 3 toxicity, at any time during the treatment cycle, delay treatment until resolved to Grade 0 1 and then resume treatment with docetaxel 55 mg/m?.
  • For any subsequent appearances of toxicities, or any Grade 4 toxicities, discontinue the docetaxel dose.

For trastuzumab dose modifications, see trastuzumab summary of product characteristics.

In combination with cisplatin and 5-fluorouracil
If an episode of febrile neutropenia, prolonged neutropenia or neutropenic infection occurs despite G CSF use, the docetaxel dose should be reduced from 75 to 60 mg/m2. If subsequent episodes of complicated neutropenia occur the docetaxel dose should be reduced from 60 to 45 mg/m2. In case of Grade 4 thrombocytopenia the docetaxel dose should be reduced from 75 to 60 mg/m2. Patients should not be retreated with subsequent cycles of docetaxel until neutrophils recover to a level > 1,500 cells/mm3?and platelets recover to a level > 100,000 cells/mm3. Discontinue treatment if these toxicities persist (see section 4.4).

Recommended dose modifications for toxicities in patients treated with docetaxel in combination with cisplatin and 5 fluorouracil (5 FU):

ToxicityDose adjustment
Diarrhoea grade 3First episode: reduce 5-FU dose by 20%.Second episode: then reduce docetaxel dose by 20%.
Diarrhoea grade 4First episode: reduce docetaxel and 5-FU doses by 20%.Second episode: discontinue treatment.
Stomatitis/mucositis grade 3First episode: reduce 5-FU dose by 20%.Second episode: stop 5-FU only, at all subsequent cycles.

Third episode: reduce docetaxel dose by 20%.

Stomatitis/mucositis grade 4First episode: stop 5-FU only, at all subsequent cycles.Second episode: reduce docetaxel dose by 20%.

For cisplatin and 5 fluorouracil dose adjustments, see the corresponding summary of product characteristics.

In the pivotal SCCHN studies patients who experienced complicated neutropenia (including prolonged neutropenia, febrile neutropenia, or infection), it was recommended to use G CSF to provide prophylactic coverage (eg, day 6 15) in all subsequent cycles.

Special populations

Patients with hepatic impairment
Based on pharmacokinetic data with docetaxel at 100 mg/m? as single agent, patients who have both elevations of transaminase (ALT and/or AST) greater than 1.5 times the upper limit of the normal range (ULN) and alkaline phosphatase greater than 2.5 times the ULN, the recommended dose of docetaxel is 75 mg/m2?(see sections 4.4 and 5.2). For those patients with serum bilirubin > ULN and/or ALT and AST > 3.5 times the ULN associated with alkaline phosphatase > 6 times the ULN, no dose-reduction can be recommended and docetaxel should not be used unless strictly indicated.

In combination with cisplatin and 5 fluorouracil for the treatment of patients with gastric adenocarcinoma, the pivotal clinical study excluded patients with ALT and/or AST > 1.5 ? ULN associated with alkaline phosphatase > 2.5 ? ULN, and bilirubin > 1 x ULN; for these patients, no dose-reductions can be recommended and docetaxel should not be used unless strictly indicated. No data are available in patients with hepatic impairment treated by docetaxel in combination in the other indications.

Paediatric population
The safety and efficacy of docetaxel in nasopharyngeal carcinoma in children aged 1 month to less than 18 years have not yet been established.

There is no relevant use of docetaxel in the paediatric population in the indications breast cancer, non-small cell lung cancer, prostate cancer, gastric carcinoma and head and neck cancer, not including type II and III less differentiated nasopharyngeal carcinoma.

Elderly patients
Based on a population pharmacokinetic analysis, there are no special instructions for use in the elderly.

In combination with capecitabine, for patients 60 years of age or more, a starting dose reduction of capecitabine to 75% is recommended (see capecitabine summary of product characteristics).

4.3 Contraindications
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.

Patients with baseline neutrophil count of < 1,500 cells/mm3.

Patients with severe liver impairment (see sections 4.2 and 4.4).

Contraindications for other medicinal products also apply, when combined with docetaxel.

4.4 Special warnings and precautions for use
For breast and non-small cell lung cancers, premedication consisting of an oral corticosteroid, such as dexamethasone 16 mg per day (e.g. 8 mg BID) for 3 days starting 1 day prior to docetaxel administration, unless contraindicated, can reduce the incidence and severity of fluid retention as well as the severity of hypersensitivity reactions. For prostate cancer, the premedication is oral dexamethasone 8 mg, 12 hours, 3 hours and 1 hour before the docetaxel infusion (see section 4.2).

Haematology
Neutropenia is the most frequent adverse reaction of docetaxel. Neutrophil nadirs occurred at a median of 7 days but this interval may be shorter in heavily pre-treated patients. Frequent monitoring of complete blood counts should be conducted on all patients receiving docetaxel. Patients should be retreated with docetaxel when neutrophils recover to a level ? 1,500 cells/mm3?(see section 4.2).

In the case of severe neutropenia (< 500 cells/mm3?for seven days or more) during a course of docetaxel therapy, a reduction in dose for subsequent courses of therapy or the use of appropriate symptomatic measures are recommended (see section 4.2).

In patients treated with docetaxel in combination with cisplatin and 5 fluorouracil (TCF), febrile neutropenia and neutropenic infection occurred at lower rates when patients received prophylactic G CSF. Patients treated with TCF should receive prophylactic G CSF to mitigate the risk of complicated neutropenia (febrile neutropenia, prolonged neutropenia or neutropenic infection). Patients receiving TCF should be closely monitored (see sections 4.2 and 4.8).

In patients treated with docetaxel in combination with doxorubicin and cyclophosphamide (TAC), febrile neutropenia and/or neutropenic infection occurred at lower rates when patients received primary G-CSF prophylaxis. Primary G-CSF prophylaxis should be considered in patients who receive adjuvant therapy with TAC for breast cancer to mitigate the risk of complicated neutropenia (febrile neutropenia, prolonged neutropenia or neutropenic infection). Patients receiving TAC should be closely monitored (see sections 4.2 and 4.8).

Hypersensitivity reactions
Patients should be observed closely for hypersensitivity reactions especially during the first and second infusions. Hypersensitivity reactions may occur within a few minutes following the initiation of the infusion of docetaxel, thus facilities for the treatment of hypotension and bronchospasm should be available. If hypersensitivity reactions occur, minor symptoms such as flushing or localised cutaneous reactions do not require interruption of therapy. However, severe reactions, such as severe hypotension, bronchospasm or generalised rash/erythema require immediate discontinuation of docetaxel and appropriate therapy. Patients who have developed severe hypersensitivity reactions should not be re-challenged with docetaxel. Patients who have previously experienced a hypersensitivity reaction to paclitaxel may be at risk to develop hypersensitivity reaction to docetaxel, including more severe hypersensitivity reaction. These patients should be closely monitored during initiation of docetaxel therapy.

Cutaneous reactions
Localised skin erythema of the extremities (palms of the hands and soles of the feet) with oedema followed by desquamation has been observed. Severe symptoms such as eruptions followed by desquamation which lead to interruption or discontinuation of docetaxel treatment were reported (see section 4.2).

Fluid retention
Patients with severe fluid retention such as pleural effusion, pericardial effusion and ascites should be monitored closely.

Respiratory disorders
Acute respiratory distress syndrome, interstitial pneumonia/pneumonitis, interstitial lung disease, pulmonary fibrosis and respiratory failure have been reported and may be associated with fatal outcome. Cases of radiation pneumonitis have been reported in patients receiving concomitant radiotherapy.

If new or worsening pulmonary symptoms develop, patients should be closely monitored, promptly investigated, and appropriately treated. Interruption of docetaxel therapy is recommended until diagnosis is available. Early use of supportive care measures may help improve the condition. The benefit of resuming docetaxel treatment must be carefully evaluated.

Patients with liver impairment
In patients treated with docetaxel at 100 mg/m2?as single agent who have serum transaminase levels (ALT and/or AST) greater than 1.5 times the ULN concurrent with serum alkaline phosphatase levels greater than 2.5 times the ULN, there is a higher risk of developing severe adverse reactions such as toxic deaths including sepsis and gastrointestinal haemorrhage which can be fatal, febrile neutropenia, infections, thrombocytopenia, stomatitis and asthenia. Therefore, the recommended dose of docetaxel in those patients with elevated liver function test (LFTs) is 75 mg/m2?and LFTs should be measured at baseline and before each cycle (see section 4.2).

For patients with serum bilirubin levels > ULN and/or ALT and AST > 3.5 times the ULN concurrent with serum alkaline phosphatase levels > 6 times the ULN, no dose-reduction can be recommended and docetaxel should not be used unless strictly indicated.

In combination with cisplatin and 5 fluorouracil for the treatment of patients with gastric adenocarcinoma, the pivotal clinical study excluded patients with ALT and/or AST > 1.5 ? ULN associated with alkaline phosphatase > 2.5 ? ULN, and bilirubin > 1 x ULN; for these patients, no dose-reductions can be recommended and docetaxel should not be used unless strictly indicated. No data are available in patients with hepatic impairment treated by docetaxel in combination in the other indications.

Patients with renal impairment
There are no data available in patients with severely impaired renal function treated with docetaxel.

Nervous system
The development of severe peripheral neurotoxicity requires a reduction of dose (see section 4.2).

Cardiac toxicity
Heart failure has been observed in patients receiving docetaxel in combination with trastuzumab, particularly following anthracycline (doxorubicin or epirubicin)-containing chemotherapy. This may be moderate to severe and has been associated with death (see section 4.8).

When patients are candidates for treatment with docetaxel in combination with trastuzumab, they should undergo baseline cardiac assessment. Cardiac function should be further monitored during treatment (e.g. every three months) to help identify patients who may develop cardiac dysfunction. For more details see summary of product characteristics of trastuzumab.

Ventricular arrhythmia including ventricular tachycardia (sometimes fatal) has been reported in patients treated with docetaxel in combination regimens including doxorubicin, 5-fluorouracil and/ or cyclophosphamide (see section 4.8).

Baseline cardiac assessment is recommended.

Eye disorders
Cystoid macular oedema (CMO) has been reported in patients treated with docetaxel. Patients with impaired vision should undergo a prompt and complete ophthalmologic examination. In case CMO is diagnosed, docetaxel treatment should be discontinued and appropriate treatment initiated (see section 4.8).

Others
Contraceptive measures must be taken by both men and women during treatment and for men at least 6 months after cessation of therapy (see section 4.6).

The concomitant use of docetaxel with strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin, indinavir, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin and voriconazole) should be avoided (see section 4.5).

Additional cautions for use in adjuvant treatment of breast cancer

Complicated neutropenia
For patients who experience complicated neutropenia (prolonged neutropenia, febrile neutropenia or infection), G CSF and dose reduction should be considered (see section 4.2).

Gastrointestinal reactions
Symptoms such as early abdominal pain and tenderness, fever, diarrhoea, with or without neutropenia, may be early manifestations of serious gastrointestinal toxicity and should be evaluated and treated promptly.

Congestive heart failure (CHF)
Patients should be monitored for symptoms of congestive heart failure during therapy and during the follow up period. In patients treated with the TAC regimen for node positive breast cancer, the risk of CHF has been shown to be higher during the first year after treatment (see section 4.8 and 5.1).

Leukaemia
In the docetaxel, doxorubicin and cyclophosphamide (TAC) treated patients, the risk of delayed myelodysplasia or myeloid leukaemia requires haematological follow up.

Patients with 4+ nodes
As the benefit observed in patient with 4+ nodes was not statistically significant on disease-free survival (DFS) and overall survival (OS), the positive benefit/risk ratio for TAC in patients with 4+ nodes was not fully demonstrated at the final analysis (see section 5.1).

Older people
There are limited data available in patients > 70 years of age on docetaxel use in combination with doxorubicin and cyclophosphamide.

Of the 333 patients treated with docetaxel every three weeks in a prostate cancer study, 209 patients were 65 years of age or greater and 68 patients were older than 75 years. In patients treated with docetaxel every three weeks, the incidence of related nail changes occurred at a rate ? 10% higher in patients who were 65 years of age or greater compared to younger patients. The incidence of related fever, diarrhoea, anorexia, and peripheral oedema occurred at rates ? 10% higher in patients who were 75 years of age or greater versus less than 65 years.

Among the 300 (221 patients in the phase III part of the study and 79 patients in the phase II part) patients treated with docetaxel in combination with cisplatin and 5 fluorouracil in the gastric cancer study, 74 were 65 years of age or older and 4 patients were 75 years of age or older. The incidence of serious adverse events was higher in the elderly patients compared to younger patients. The incidence of the following adverse events (all grades): lethargy, stomatitis, neutropenic infection occurred at rates ? 10% higher in patients who were 65 years of age or older compared to younger patients.

Elderly patients treated with TCF should be closely monitored.

Excipients
This medicinal product contains 50 vol % ethanol (alcohol), i.e. 395 mg (0.5 ml) ethanol anhydrous per 1 ml vial, equivalent to 10 ml of beer or 4 ml wine per 1 ml vial, 1.58 g (2 ml) ethanol anhydrous per 4 ml vial, equivalent to 40 ml of beer or 17 ml wine per 4 ml vial, or 3.16 g (4 ml) ethanol anhydrous per vial of 8 ml fill volume, equivalent to 80 ml beer or 33 ml wine per 8 ml vial.

Harmful for those suffering from alcoholism.

To be taken into account in pregnant or breast-feeding women, children and high-risk groups such as patients with liver disease, or epilepsy.

4.5 Interaction with other medicinal products and other forms of interaction
The amount of alcohol in this medicinal product may alter the effects of other medicinal products.

In vitro?studies have shown that the metabolism of docetaxel may be modified by the concomitant administration of compounds which induce, inhibit or are metabolised by (and thus may inhibit the enzyme competitively) cytochrome P450-3A such as ciclosporine, ketoconazole and erythromycin. As a result, caution should be exercised when treating patients with these medicinal products as concomitant therapy since there is a potential for a significant interaction.

In case of combination with CYP3A4 inhibitors, the occurrence of docetaxel adverse reactions may increase, as a result of reduced metabolism. If the concomitant use of a strong CYP3A4 inhibitor (e.g., ketoconazole, itraconazole, clarithromycin, indinavir, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin and voriconazole) cannot be avoided, a close clinical surveillance is warranted and a dose-adjustment of docetaxel may be suitable during the treatment with the strong CYP3A4 inhibitor (see section 4.4). In a pharmacokinetic study with 7 patients, the co-administration of docetaxel with the strong CYP3A4 inhibitor ketoconazole leads to a significant decrease in docetaxel clearance by 49%.

Docetaxel pharmacokinetics in the presence of prednisone was studied in patients with metastatic prostate cancer. Docetaxel is metabolised by CYP3A4 and prednisone is known to induce CYP3A4. No statistically significant effect of prednisone on the pharmacokinetics of docetaxel was observed.

Docetaxel is highly protein bound (> 95%). Although the possible?in vivo?interaction of docetaxel with concomitantly administered medicinal product has not been investigated formally,?in vitro?interactions with tightly protein-bound agents such as erythromycin, diphenhydramine, propranolol, propafenone, phenytoin, salicylate, sulfamethoxazole and sodium valproate did not affect protein binding of docetaxel. In addition, dexamethasone did not affect protein binding of docetaxel. Docetaxel did not influence the binding of digitoxin.

The pharmacokinetics of docetaxel, doxorubicin and cyclophosphamide were not influenced by their co administration. Limited data from a single uncontrolled study were suggestive of an interaction between docetaxel and carboplatin. When combined to docetaxel, the clearance of carboplatin was about 50% higher than values previously reported for carboplatin monotherapy.

4.6 Fertility, pregnancy and lactation

Pregnancy
There is no information on the use of docetaxel in pregnant women. Docetaxel has been shown to be both embryotoxic and foetotoxic in rabbits and rats, and to reduce fertility in rats. As with other cytotoxic medicinal products, docetaxel may cause foetal harm when administered to pregnant women. Therefore, docetaxel must not be used during pregnancy unless clearly indicated.

Women of childbearing age receiving docetaxel should be advised to avoid becoming pregnant, and to inform the treating physician immediately should this occur.

Breast-feeding
Docetaxel is a lipophilic substance but it is not known whether it is excreted in human milk. Consequently, because of the potential for adverse reactions in nursing infants, breast feeding must be discontinued for the duration of docetaxel therapy.

Contraception in males and females
An effective method of contraception should be used during treatment.

Fertility
In non-clinical studies, docetaxel has genotoxic effects and may alter male fertility (see section 5.3). Therefore, men being treated with docetaxel are advised not to father a child during and up to 6 months after treatment and to seek advice on conservation of sperm prior to treatment.

4.7 Effects on ability to drive and use machines
No studies on the effects on the ability to drive and use machines have been performed. The amount of alcohol in this medicinal product may impair the ability to drive or use machines (see section 4.4).

4.8 Undesirable effects
Summary of the safety profile for all indications
The adverse reactions considered to be possibly or probably related to the administration of docetaxel have been obtained in:

  • 1312 and 121 patients who received 100 mg/m? and 75 mg/m? of docetaxel as a single agent respectively.
  • 258 patients who received docetaxel in combination with doxorubicin.
  • 406 patients who received docetaxel in combination with cisplatin.
  • 92 patients treated with docetaxel in combination with trastuzumab.
  • 255 patients who received docetaxel in combination with capecitabine.
  • 332 patients who received docetaxel in combination with prednisone or prednisolone (clinically important treatment related adverse events are presented).
  • 1276 patients (744 and 532 in TAX 316 and GEICAM 9805 respectively) who received docetaxel in combination with doxorubicin and cyclophosphamide (clinically important treatment related adverse events are presented).
  • 300 gastric adenocarcinoma patients (221 patients in the phase III part of the study and 79 patients in the phase II part) who received docetaxel in combination with cisplatin and 5 fluorouracil (clinically important treatment related adverse events are presented).
  • 174 and 251 head and neck cancer patients who received docetaxel in combination with cisplatin and 5 fluorouracil (clinically important treatment related adverse events are presented).

These reactions were described using the NCI Common Toxicity Criteria (grade 3 = G3; grade 3 4 = G3/4; grade 4 = G4), the COSTART and the MedDRA terms.

Frequencies are defined as:

very common(? 1/10)
common(? 1/100 to < 1/10)
uncommon? 1/1000 to < 1/100)
rare(? 1/10,000 to < 1/1000)
very rare(< 1/10000)
not known(cannot be estimated from available data)

Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness.

The most commonly reported adverse reactions of docetaxel alone are: neutropenia (which was reversible and not cumulative; the median day to nadir was 7 days and the median duration of severe neutropenia (< 500 cells/mm3) was 7 days), anaemia, alopecia, nausea, vomiting, stomatitis, diarrhoea and asthenia. The severity of adverse events of docetaxel may be increased when docetaxel is given in combination with other chemotherapeutic agents.

For combination with trastuzumab, adverse events (all grades) reported in ? 10% are displayed. There was an increased incidence of SAEs (40% vs. 31%) and Grade 4 AEs (34% vs. 23%) in the trastuzumab combination arm compared to docetaxel monotherapy.

For combination with capecitabine, the most frequent treatment-related undesirable effects (? 5%) reported in a phase III study in breast cancer patients failing anthracycline treatment are presented (see capecitabine summary of product characteristics).

The following adverse reactions are frequently observed with docetaxel:

Immune system disorders

Hypersensitivity reactions have generally occurred within a few minutes following the start of the infusion of docetaxel and were usually mild to moderate. The most frequently reported symptoms were flushing, rash with or without pruritus, chest tightness, back pain, dyspnoea and fever or chills. Severe reactions were characterised by hypotension and/or bronchospasm or generalized rash/erythema (see section 4.4).

Nervous system disorders
The development of severe peripheral neurotoxicity requires a reduction of dose (see sections 4.2 and 4.4). Mild to moderate neuro-sensory signs are characterised by paresthesia, dysesthesia or pain including burning. Neuro-motor events are mainly characterised by weakness.

Skin and subcutaneous tissue disorders
Reversible cutaneous reactions have been observed and were generally considered as mild to moderate. Reactions were characterised by a rash including localised eruptions mainly on the feet and hands (including severe hand and foot syndrome), but also on the arms, face or thorax, and frequently associated with pruritus. Eruptions generally occurred within one week after the docetaxel infusion. Less frequently, severe symptoms such as eruptions followed by desquamation which rarely lead to interruption or discontinuation of docetaxel treatment were reported (see sections 4.2 and 4.4). Severe nail disorders are characterised by hypo- or hyperpigmentation and sometimes pain and onycholysis.

General disorders and administration site conditions
Infusion site reactions were generally mild and consisted of hyper pigmentation, inflammation, redness or dryness of the skin, phlebitis or extravasation and swelling of the vein.

Fluid retention includes events such as peripheral oedema and less frequently pleural effusion, pericardial effusion, ascites and weight gain. The peripheral oedema usually starts at the lower extremities and may become generalised with a weight gain of 3 kg or more. Fluid retention is cumulative in incidence and severity (see section 4.4).

Tabulated list of adverse reactions in breast cancer for docetaxel 100 mg/m? single agent

MedDRA system organ classesVery common adverse reactionsCommon adverse reactionsUncommon adverse reactions
Infections and infestationsInfections (G3/4: 5.7%; including sepsis and pneumonia, fatal in 1.7%)Infection associated with G4 neutropenia (G3/4: 4.6%)
Blood and lymphatic system disordersNeutropenia (G4: 76.4%);Anaemia (G3/4: 8.9%);

Febrile neutropenia

Thrombocytopenia (G4: 0.2%)
Immune system disordersHypersensitivity (G3/4: 5.3%)
Metabolism and nutrition disordersAnorexia
Nervous system disordersPeripheral sensory neuropathy (G3: 4.1%);Peripheral motor neuropathy (G3/4: 4%);

Dysgeusia (severe: 0.07%)

Cardiac disordersArrhythmia (G3/4: 0.7%)Cardiac failure
Vascular disordersHypotension;Hypertension;

Haemorrhage

Respiratory, thoracic and mediastinal disordersDyspnoea (severe: 2.7%)
Gastrointestinal disordersStomatitis (G3/4: 5.3%);Diarrhoea (G3/4: 4%);

Nausea (G3/4: 4%);

Vomiting (G3/4: 3%)

Constipation (severe: 0.2%);Abdominal pain (severe: 1%);

Gastrointestinal haemorrhage (severe: 0.3%)

Oesophagitis (severe: 0.4%)
Skin and subcutaneous tissue disordersAlopecia;Skin reaction (G3/4: 5.9%);

Nail disorders (severe: 2.6%)

Musculoskeletal and connective tissue disordersMyalgia (severe: 1.4%)Arthralgia
General disorders and administration site conditionsFluid retention (severe: 6.5%);Asthenia (severe: 11.2%);

Pain

Infusion site reaction;Non-cardiac chest pain (severe: 0.4%)
InvestigationsG3/4 Blood bilirubin increased (< 5%);G3/4 Blood alkaline phosphatase increased (< 4%);

G3/4 AST increased (< 3%);

G3/4 ALT increased (< 2%)

Description of selected adverse reactions in breast cancer for docetaxel 100 mg/m2?single agent

Blood and lymphatic system disorders

Rare: bleeding episodes associated with grade 3/4 thrombocytopenia.

Nervous system disorders

Reversibility data are available among 35.3% of patients who developed neurotoxicity following docetaxel treatment at 100 mg/m? as single agent. The events were spontaneously reversible within 3 months.

Skin and subcutaneous tissue disorders

Very rare: one case of alopecia non-reversible at the end of the study. 73% of the cutaneous reactions were reversible within 21 days.

General disorders and administration site conditions

The median cumulative dose to treatment discontinuation was more than 1,000 mg/m2?and the median time to fluid retention reversibility was 16.4 weeks (range 0 to 42 weeks). The onset of moderate and severe retention is delayed (median cumulative dose: 818.9 mg/m2) in patients with premedication compared with patients without premedication (median cumulative dose: 489.7 mg/m2); however, it has been reported in some patients during the early courses of therapy.

Tabulated list of adverse reactions in non-small cell lung cancer for docetaxel 75mg/m? single agent:

MedDRA system organ classesVery common adverse reactionsCommon adverse reactions
Infections and infestationsInfections (G3/4: 5%)
Blood and lymphatic system disordersNeutropenia (G4: 54.2%);Anaemia (G3/4: 10.8%);

Thrombocytopenia (G4: 1.7%)

Febrile neutropenia
Immune system disordersHypersensitivity (no severe)
Metabolism and nutrition disordersAnorexia
Nervous system disordersPeripheral sensory neuropathy(G3/4: 0.8%)Peripheral motor neuropathy(G3/4: 2.5%)
Cardiac disordersArrhythmia (no severe)
Vascular disordersHypotension
Gastrointestinal disordersNausea (G3/4: 3.3%);Stomatitis (G3/4: 1.7%);

Vomiting (G3/4: 0.8%);

Diarrhea (G3/4: 1.7%)

Constipation
Skin and subcutaneous tissue disordersAlopecia;Skin reaction (G3/4: 0.8%)Nail disorders (severe 0.8%)
Musculoskeletal and connective tissue disordersMyalgia
General disorders and administration site conditionsAsthenia (severe 12.4%);Fluid retention (severe 0.8%);

Pain

InvestigationsG3/4 Blood bilirubin increased (<2%)

Tabulated list of adverse reactions in breast cancer for docetaxel 75mg/m? in combination with doxorubicin:

MedDRA system organ classesVery common adverse reactionsCommon adverse reactionsUncommon adverse reactions
Infections and infestationsInfection (G3/4: 7.8%)
Blood and lymphatic system disordersNeutropenia (G4: 91.7%);Anaemia (G3/4: 9.4%);

Febrile neutropenia;

Thrombocytopenia (G4: 0.8 %)

Immune system disordersHypersensitivity (G3/4: 1.2 %)
Metabolism and nutrition disordersAnorexia
Nervous system disordersPeripheral sensory neuropathy (G3: 0.4%)Peripheral motor neuropathy (G3/4: 0.4%)
Cardiac disordersCardiac failure;Arrhythmia (no severe)
Vascular disordersHypotension
Gastrointestinal disordersNausea (G3/4: 5%);Stomatitis (G3/4: 7.8%);

Diarrhoea (G3/4: 6.2%);

Vomiting (G3/4: 5%);

Constipation

Skin and subcutaneous tissue disordersAlopecia;Nail disorders (severe 0.4%);

Skin reaction (no severe)

Musculoskeletal and connective tissue disordersMyalgia
General disorders and administration site conditionsAsthenia (severe 8.1%);Fluid retention (severe 1.2%);

Pain

Infusion site reaction
InvestigationsG3/4 Blood bilirubin increased (< 2.5 %); G3/4 Blood alkaline phosphatase increased (< 2.5 %)G3/4 AST increased (<1 %); G3/4 ALT increased (< 1 %)

Tabulated list of adverse reactions in non-small cell lung cancer for?docetaxel 75 mg/m? in combination with cisplatin

MedDRA system organ classesVery common adverse reactionsCommon adverse reactionsUncommon adverse reactions
Infections and infestationsInfection (G3/4: 5.7%)
Blood and lymphatic system disordersNeutropenia (G4: 51.5%);Anaemia (G3/4: 6.9%);

Thrombocytopenia (G4: 0.5%)

Febrile neutropenia
Immune system disordersHypersensitivity (G3/4: 2.5%)
Metabolism and nutrition disordersAnorexia
Nervous system disordersPeripheral sensory neuropathy (G3: 3.7%);Peripheral motor neuropathy (G3/4: 2%)
Cardiac disordersArrhythmia (G3/4: 0.7%)Cardiac failure
Vascular disordersHypotension (G3/4: 0.7%)
Gastrointestinal disordersNausea (G3/4: 9.6%);Vomiting (G3/4: 7.6%);

Diarrhoea (G3/4: 6.4%);

Stomatitis (G3/4: 2%)

Constipation
Skin and subcutaneous tissue disordersAlopecia;Nail disorders (severe: 0.7%);

Skin reaction (G3/4: 0.2%)

Musculoskeletal and connective tissue disordersMyalgia (severe: 0.5%)
General disorders and administration site conditionsAsthenia (severe: 9.9%);Fluid retention (severe: 0.7%);

Fever (G3/4: 1.2%)

Infusion site reaction;Pain
InvestigationsG3/4 Blood bilirubin increased (2.1%);G3/4 ALT increased (1.3%)G3/4 AST increased (0.5%);G3/4 Blood alkaline phosphatase increased (0.3%)

Tabulated list of adverse reactions in breast cancer for docetaxel 100 mg/m? in combination with trastuzumab

MedDRA system organ classesVery common adverse reactionsCommon adverse reactions
Blood and lymphatic system disordersNeutropenia (G3/4: 32%);Febrile neutropenia (includes neutropenia associated with fever and antibiotic use) or neutropenic sepsis
Metabolism and nutrition disordersAnorexia
Psychiatric disordersInsomnia
Nervous system disordersParesthesia; Headache; Dysgeusia; Hypoaesthesia
Eye disordersLacrimation increased; Conjunctivitis
Cardiac disordersCardiac failure
Vascular disordersLymphoedema
Respiratory, thoracic and mediastinal disordersEpistaxis; Pharyngolaryngeal pain; Nasopharyngitis; Dyspnoea; Cough; Rhinorrhoea
Gastrointestinal disordersNausea; Diarrhoea; Vomiting; Constipation; Stomatitis; Dyspepsia; Abdominal pain
Skin and subcutaneous tissue disordersAlopecia; Erythema; Rash; Nail disorders
Musculoskeletal and connective tissue disordersMyalgia; Arthralgia; Pain in extremity; Bone pain; Back pain
General disorders and administration site conditionsAsthenia; Oedema peripheral; Pyrexia; Fatigue; Mucosal inflammation; Pain; Influenza like illness; Chest pain; ChillsLethargy
InvestigationsWeight increased

Description of selected adverse reactions in breast cancer for docetaxel 100 mg/m2 in combination with trastuzumab

Blood and lymphatic system disorders
Very common: Haematological toxicity was increased in patients receiving trastuzumab and docetaxel, compared with docetaxel alone (32% grade 3/4 neutropenia versus 22%, using NCI-CTC criteria). Note that this is likely to be an underestimate since docetaxel alone at a dose of 100 mg/m2?is known to result in neutropenia in 97% of patients, 76% grade 4, based on nadir blood counts. The incidence of febrile neutropenia/neutropenic sepsis was also increased in patients treated with Herceptin plus docetaxel (23% versus 17% for patients treated with docetaxel alone).

Cardiac disorders
Symptomatic cardiac failure was reported in 2.2% of the patients who received docetaxel plus trastuzumab compared to 0% of patients given docetaxel alone. In the docetaxel plus trastuzumab arm, 64% had received a prior anthracycline as adjuvant therapy compared with 55% in the docetaxel arm alone.

Tabulated list of adverse reactions in breast cancer for docetaxel 75mg/m? in combination with capecitabine:

MedDRA system organ classesVery common adverse reactionsCommon adverse reactions
Infections and infestationsOral candidiasis (G3/4: <1%)
Blood and lymphatic system disordersNeutropenia (G3/4: 63%);Anaemia (G3/4: 10%)Thrombocytopenia (G3/4: 3%)
Metabolism and nutrition disordersAnorexia (G3/4: 1%);Decreased appetiteDehydration (G3/4: 2%);
Nervous system disordersDysgeusia (G3/4: <1%);Paraesthesia (G3/4: <1%)Dizziness;Headache (G3/4: <1%);

Neuropathy peripheral

Eye disordersLacrimation increased
Respiratory, thoracic and mediastinal disordersPharyngolaryngeal pain(G3/4: 2%)Dyspnoea (G3/4: 1%);Cough (G3/4: <1%);

Epistaxis (G3/4: <1%)

Gastrointestinal disordersStomatitis (G3/4: 18%);Diarrhoea (G3/4: 14%);

Nausea (G3/4: 6%);

Vomiting (G3/4: 4%);

Constipation (G3/4: 1%);

Abdominal pain (G3/4: 2%);

Dyspepsia

Abdominal pain upper;Dry mouth
Skin and subcutaneous tissue disordersHand-foot syndrome (G3/4: 24%)Alopecia (G3/4: 6%);

Nail disorders (G3/4: 2%)

Dermatitis;Rash erythematous (G3/4: <1%); Nail discolouration;

Onycholysis (G3/4: 1%)

Musculoskeletal and connective tissue disordersMyalgia (G3/4: 2%);Arthralgia (G3/4: 1%)Pain in extremity (G3/4: <1%);Back pain (G3/4: 1%);
General disorders and administration site conditionsAsthenia (G3/4: 3%);Pyrexia (G3/4: 1%);

Fatigue/ weakness (G3/4: 5%);

Oedema peripheral (G3/4: 1%);

Lethargy;Pain
InvestigationsWeight decreased;G3/4 Blood bilirubin increased (9%)

Tabulated list of adverse reactions in prostate cancer for docetaxel 75 mg/m? in combination with prednisone or prednisolone

MedDRA system organ classesVery common adverse reactionsCommon adverse reactions
Infections and infestationsInfection (G3/4: 3.3%)
Blood and lymphatic system disordersNeutropenia (G3/4: 32%);Anaemia (G3/4: 4.9%)Thrombocytopenia (G3/4: 0.6%);Febrile neutropenia
Immune system disordersHypersensitivity (G3/4: 0.6%)
Metabolism and nutrition disordersAnorexia (G3/4: 0.6%)
Nervous system disordersPeripheral sensory neuropathy (G3/4: 1.2%);Dysgeusia (G3/4: 0%)Peripheral motor neuropathy (G3/4: 0%)
Eye disordersLacrimation increased (G3/4: 0.6%)
Cardiac disordersCardiac left ventricular function decrease (G3/4: 0.3%)
Respiratory, thoracic and mediastinal disordersEpistaxis (G3/4: 0%);Dyspnoea (G3/4: 0.6%);

Cough (G3/4: 0%)

Gastrointestinal disordersNausea (G3/4: 2.4%);Diarrhoea (G3/4: 1.2%);

Stomatitis/Pharyngitis (G3/4: 0.9%);

Vomiting (G3/4: 1.2%)

Skin and subcutaneous tissue disordersAlopecia;Nail disorders (no severe)Exfoliative rash (G3/4: 0.3%)
Musculoskeletal and connective bone disordersArthralgia (G3/4: 0.3%);Myalgia (G3/4: 0.3%)
General disorders and administration site conditionsFatigue (G3/4: 3.9%);Fluid retention (severe: 0.6%)

Tabulated list of adverse reactions in breast cancer for adjuvant therapy with docetaxel 75 mg/m2?in combination with doxorubicin and cyclophosphamide in patients with node-positive (TAX 316) and node-negative (GEICAM 9805) breast cancer ? pooled data

MedDRA system organ classesVery common adverse reactionsCommon adverse reactionsUncommon adverse reactions
Infections and infestationsInfection (G3/4: 2.4 %);Neutropenic infection.

(G3/4:2.6%)

Blood and lymphatic system disordersAnaemia (G3/4: 3 %);Neutropenia (G3/4: 59.2%);

Thrombocytopenia (G3/4: 1.6%);

Febrile neutropenia

(G3/4:NA)

Immune system disordersHypersensitivity (G3/4:0.6%)
Metabolism and nutrition disordersAnorexia (G3/4: 1.5%)
Nervous system disordersDysgeusia (G3/4: 0. 6%);Peripheral sensory neuropathy (G3/4: <0.1 %)Peripheral motor neuropathy (G3/4: 0%);Syncope (G3/4: 0%);Neurotoxicity (G3/4:0%)

Somnolence (G3/4:0%)

Eye disordersConjunctivitis (G3/4:<0.1%)Lacrimation increased (G3/4: 0.1%)
Cardiac disordersArrhythmia (G3/4: 0. 2%);
Vascular disordersHot flush (G3/4:0.5%)Hypotension (G3/4: 0%)Phlebitis (G3/4:0%)Lymphoedema (G3/4: 0%)
Respiratory, thoracic and mediastinal disordersCough (G3/4: 0%)
Gastrointestinal disordersNausea (G3/4: 5.0%);Stomatitis (G3/4: 6.0%);

Vomiting (G3/4: 4.2%);

Diarrhoea (G3/4: 3.4%);

Constipation (G3/4: 0.5%)

Abdominal pain (G3/4: 0.4%)
Skin and subcutaneous tissue disordersAlopecia (persisting: <3%)Skin disorder (G3/4: 0.6%);

Nail disorders (G3/4: 0.4%)

Musculoskeletal and connective tissue disordersMyalgia (G3/4: 0.7%);Arthralgia (G3/4: 0.2%)
Reproductive system and breast disordersAmenorrhoea (G3/4:NA)
General disorders and administration site conditionsAsthenia (G3/4: 10.0%);Pyrexia (G3/4:NA)

Oedema peripheral (G3/4: 0.2%)

InvestigationsWeight increased (G3/4:0%);Weight decreased (G3/4:0.2%)

Description of selected adverse reactions for adjuvant therapy with docetaxel 75 mg/m? in combination with doxorubicin and cyclophosphamide in patients with node-positive (TAX 316) and node-negative (GEICAM 9805) breast cancer

Nervous system disorders
In study TAX316 peripheral sensory neuropathy started during the treatment period and persisted into the follow-up period in 84 patients (11.3%) in TAC arm and 15 patients (2%) in FAC arm. At the end of the follow-up period (median follow-up time of 8 years), peripheral sensory neuropathy was observed to be ongoing in 10 patients (1.3%) in TAC arm, and in 2 patients (0.3%) in FAC arm

In GEICAM 9805 study peripheral sensory neuropathy that started during the treatment period persisted into the follow-up period in 10 patients (1.9%) in TAC arm and 4 patients (0.8 %) in FAC arm. At the end of the follow-up period (median follow-up time of 10 years and 5 months), peripheral sensory neuropathy was observed to be ongoing in 3 patients (0.6%) in TAC arm, and in 1 patient (0.2%) in FAC arm.

Cardiac disorders
In study TAX316, 26 patients (3.5%) in the TAC arm and 17 patients (2.3%) in the FAC arm experienced congestive heart failure. All except one patient in each arm were diagnosed with CHF more than 30 days after the treatment period. Two patients in the TAC arm and 4 patients in the FAC arm died because of cardiac failure.

In GEICAM 9805 study, 3 patients (0.6 %) in TAC arm and 3 patients (0.6 %) in FAC arm developed congestive heart failure during the follow-up period. At the end of the follow-up period (actual median follow-up time of 10 years and 5 months), no patients had CHF in TAC arm and 1patient in TAC arm died because of dilated cardiomyopathy, and CHF was observed to be ongoing in 1 patient (0.2%) in FAC arm.

Skin and subcutaneous tissue disorders
In study TAX 316, alopecia persisting into the follow-up period after the end of chemotherapy was reported in 687 of 744 TAC patients (92.3%) and 645 of 736 FAC patients (87.6%).

At the end of the follow-up period, (actual median follow-up time of 8 years), alopecia was observed to be ongoing in 29 TAC patients (3.9%) and 16 FAC patients (2.2%).

In GEICAM 9805 study alopecia that started during the treatment period and persisted into the follow-up period was observed to be ongoing in 49 patients (9.2 %) in TAC arm and 35 patients (6.7 %) in FAC arm. Alopecia related to study drug started or worsened during the follow-up period in 42 patients (7.9 %) in TAC arm and 30 patients (5.8 %) in FAC arm. At the end of the follow-up period (median follow-up time of 10 years and 5 months), alopecia was observed to be ongoing in 3 patients (0.6%) in TAC arm, and in 1 patient (0.2%) in FAC arm.

Reproductive system and breast disorders
In TAX316 amenorrhoea that started during the treatment period and persisted into the follow-up period after the end of chemotherapy was reported in 202 of 744 TAC patients (27.2%) and 125 of 736 FAC patients (17.0%). Amenorrhea was observed to be ongoing at the end of follow up period (median follow-up time of 8 years) in 121 of 744 TAC patients (16.3%) and 86 FAC patients (11.7%).

In GEICAM 9805 study amenorrhoea that started during the treatment period and persisted into the follow-up period was observed to be ongoing in 18 patients (3.4 %) in TAC arm and 5 patients (1.0 %) in FAC arm. At the end of the follow-up period (median follow-up time of 10 years and 5 months), amenorrhea was observed to be ongoing in 7 patients (1.3%) in TAC arm, and in 4 patients (0.8%) in FAC arm.

General disorders and administration site conditions
In study TAX316, peripheral oedema that started during the treatment period and persisted into the follow-up period after the end of chemotherapy was observed in 119 of 744 TAC patients (16.0%) and 23 of 736 FAC patients (3.1%). At the end of the follow-up period (actual median follow-up time of 8 years), peripheral oedema was ongoing in 19 TAC patients (2.6%) and 4 FAC patients (0.5%)

In study TAX316 lymphoedema that started during the treatment period and persisted into the follow-up period after the end of chemotherapy was reported in 11 of 744 TAC patients (1.5%) and 1 of 736 FAC patients (0.1%). At the end of the follow-up period (actual median follow-up time of 8 years), lymphoedema was observed to be ongoing in 6 TAC patients (0.8%) and 1 FAC patient (0.1%).

In study TAX316 asthenia that started during the treatment period and persisted into the follow-up period after the end of chemotherapy was reported in 236 of 744 TAC patients (31.7%) and 180 of 736 FAC patients (24.5%). At the end of the follow-up period (actual median follow-up time of 8 years), asthenia was observed to be ongoing in 29 TAC patients (3.9%) and 16 FAC patients (2.2%).

In study GEICAM 9805 peripheral oedema that started during the treatment period persisted into the follow-up period in 4 patients (0.8%) in TAC arm and in 2 patients (0.4%) in FAC arm. At the end of the follow-up period (median follow-up time of 10 years and 5 months), no patients (0%) in TAC arm had peripheral oedema and it was observed to be ongoing in 1 patient (0.2%) in FAC arm. Lymphoedema that started during the treatment period persisted into the follow-up period in 5 patients (0.9%) in TAC arm and 2 patients (0.4%) om FAC arm. At the end of the follow-up period, lymphoedema was observed to be ongoing in 4 patients (0.8%) in TAC arm, and in 1 patient (0.2%) in FAC arm.

Asthenia that started during the treatment period and persisted into the follow-up period was observed to be ongoing in 12 patients (2.3 %) in TAC arm and 4 patients (0.8 %) in FAC arm. At the end of the follow-up period, asthenia was observed to be ongoing in 2 patients (0.4%) in TAC arm, and in 2 patients (0.4%) in FAC arm.

Acute leukaemia / Myelodysplastic syndrome.
After 10 years of follow up in study TAX316, acute leukaemia was reported in 3 of 744 TAC patients (0.4%) and in 1 of 736 FAC patients (0.1%). One TAC patient (0.1%) and 1 FAC patient (0.1%) died due to AML during the follow-up period (median follow-up time of 8 years). Myelodysplastic syndrome was reported in 2 of 744 TAC patients (0.3%) and in 1 of 736 FAC patients (0.1%).

After 10 years of follow-up in GEICAM 9805 study, acute leukaemia occurred in 1 of 532 (0.2%) patients in TAC arm. No cases were reported in patients in FAC arm. No patient was diagnosed with myelodysplastic syndrome in either treatment groups.

Neutropenic complications
Table below shows that the incidence of Grade 4 neutropenia, febrile neutropenia and neutropenic infection was decreased in patients who received primary G-CSF prophylaxis after it was made mandatory in the TAC arm ? GEICAM study.

Neutropenic complications in patients receiving TAC with or without primary G-CSF prophylaxis (GEICAM 9805)

Without primaryG-CSF prophylaxis

(n = 111)

n (%)

With primaryG-CSF prophylaxis

(n = 421)

n (%)

Neutropenia (Grade 4)104 (93.7)135 (32.1)
Febrile neutropenia28 (25.2)23 (5.5)
Neutropenic infection14 (12.6)21 (5.0)
Neutropenic infection(Grade 3-4)2 (1.8)5 (1.2)

Tabulated list of adverse reactions in gastric adenocarcinoma cancer for docetaxel 75 mg/m? in combination with cisplatin and 5 fluorouracil

MedDRA system organ classesVery common adverse reactionsCommon adverse reactions
Infections and infestationsNeutropenic infection;Infection (G3/4: 11.7%)
Blood and lymphatic system disordersAnaemia (G3/4: 20.9%);Neutropenia (G3/4: 83.2%);

Thrombocytopenia (G3/4: 8.8%);

Febrile neutropenia

Immune system disordersHypersensitivity (G3/4: 1.7%)
Metabolism and nutrition disordersAnorexia (G3/4: 11.7%)
Nervous system disordersPeripheral sensory neuropathy (G3/4: 8.7%)Dizziness (G3/4: 2.3%);Peripheral motor neuropathy (G3/4: 1.3%)
Eye disordersLacrimation increased (G3/4: 0%)
Ear and labyrinth disordersHearing impaired (G3/4: 0%)
Cardiac disordersArrhythmia (G3/4: 1.0%)
Gastrointestinal disordersDiarrhoea (G3/4: 19.7%);Nausea (G3/4: 16%);

Stomatitis (G3/4: 23.7%);

Vomiting (G3/4: 14.3%)

Constipation (G3/4: 1.0%);Gastrointestinal pain (G3/4: 1.0%);

Oesophagitis/dysphagia/odynophagia (G3/4: 0.7%)

Skin and subcutaneous tissue disordersAlopecia (G3/4: 4.0%)Rash pruritus (G3/4: 0.7%);Nail disorders (G3/4: 0.7%);

Skin exfoliation (G3/4: 0%)

General disorders and administration site conditionsLethargy (G3/4: 19.0%);Fever (G3/4: 2.3%);

Fluid retention (severe/life-threatening: 1%)

Description of selected adverse reactions in gastric adenocarcinoma cancer for docetaxel 75 mg/m2 in combination with cisplatin and 5-fluorouracil

Blood and lymphatic system disorders
Febrile neutropenia and neutropenic infection occurred in 17.2% and 13.5% of patients respectively, regardless of G CSF use. G CSF was used for secondary prophylaxis in 19.3% of patients (10.7% of the cycles). Febrile neutropenia and neutropenic infection occurred respectively in 12.1% and 3.4% of patients when patients received prophylactic G CSF, in 15.6% and 12.9% of patients without prophylactic G CSF (see section 4.2).

Tabulated list of adverse reactions in head and neck cancer for Docetaxel 75 mg/m? in combination with cisplatin and 5-fluorouracil

  • Induction chemotherapy followed by radiotherapy (TAX 323)
MedDRA system organ classesVery common adverse reactionsCommon adverse reactionsUncommon adverse reactions
Infections and infestationsInfection (G3/4: 6.3%);Neutropenic infection
Neoplasms benign, malignant and unspecified (incl cysts and polyps)Cancer pain (G3/4: 0.6%)
Blood and lymphatic system disordersNeutropenia (G3/4: 76.3%);Anaemia (G3/4: 9.2%);

Thrombocytopenia (G3/4: 5.2%)

Febrile neutropenia
Immune system disordersHypersensitivity (no severe)
Metabolism and nutrition disordersAnorexia (G3/4: 0.6%)
Nervous system disordersDysgeusia/Parosmia;Peripheral sensory neuropathy (G3/4: 0.6%)Dizziness
Eye disordersLacrimation increased;Conjunctivitis
Ear and labyrinth disordersHearing impaired
Cardiac disordersMyocardial ischemia (G3/4:1.7%)Arrhythmia (G3/4: 0.6%)
Vascular disordersVenous disorder (G3/4: 0.6%)
Gastrointestinal disordersNausea (G3/4: 0.6%);Stomatitis (G3/4: 4.0%);

Diarrhoea (G3/4: 2.9%);

Vomiting (G3/4: 0.6%)

Constipation;Esophagitis/dysphagia/ odynophagia (G3/4: 0.6%);

Abdominal pain;

Dyspepsia;

Gastrointestinal haemorrhage (G3/4: 0.6%)

Skin and subcutaneous tissue disordersAlopecia (G3/4: 10.9%)Rash pruritic;Dry skin;

Skin exfoliative (G3/4: 0.6%)

Musculoskeletal and connective tissue disordersMyalgia (G3/4: 0.6%)
General disorders and administration site conditionsLethargy (G3/4: 3.4%);Pyrexia (G3/4: 0.6%);

Fluid retention;

Oedema

InvestigationsWeight increased
  • Induction chemotherapy followed by chemoradiotherapy (TAX 324)
MedDRA system organ classesVery common adverse reactionsCommon adverse reactionsUncommon adverse reactions
Infections and infestationsInfection (G3/4: 3.6%)Neutropenic infection
Neoplasms benign, malignant and unspecified (incl cysts and polyps)Cancer pain (G3/4: 1.2%)
Blood and lymphatic system disordersNeutropenia (G3/4: 83.5%);Anaemia (G3/4: 12.4%);

Thrombocytopenia (G3/4: 4.0%);

Febrile neutropenia

Immune system disordersHypersensitivity
Metabolism and nutrition disordersAnorexia (G3/4: 12.0%)
Nervous system disordersDysgeusia/Parosmia (G3/4: 0.4%);Peripheral sensory neuropathy (G3/4: 1.2%)Dizziness (G3/4: 2.0%);Peripheral motor neuropathy (G3/4: 0.4%)
Eye disordersLacrimation increasedConjunctivitis
Ear and labyrinth disordersHearing impaired (G3/4: 1.2%)
Cardiac disordersArrhythmia (G3/4: 2.0%)Ischemia myocardial
Vascular disordersVenous disorder
Gastrointestinal disordersNausea (G3/4: 13.9%);Stomatitis (G3/4: 20.7%);

Vomiting (G3/4: 8.4%);

Diarrhoea (G3/4: 6.8%);

Esophagitis/dysphagia/ odynophagia (G3/4: 12.0%);

Constipation (G3/4: 0.4%)

Dyspepsia (G3/4: 0.8%);Gastrointestinal pain (G3/4: 1.2%);

Gastrointestinal haemorrhage (G3/4: 0.4%)

Skin and subcutaneous tissue disordersAlopecia (G3/4: 4.0%);Rash pruriticDry skin ;Desquamation
Musculoskeletal, connective tissue bone disordersMyalgia (G3/4: 0.4%)
General disorders and administration site conditionsLethargy (G3/4: 4.0%);Pyrexia (G3/4: 3.6%);

Fluid retention (G3/4: 1.2%);

Oedema (G3/4: 1.2%)

InvestigationsWeight decreasedWeight increased

Post-marketing experience
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Cases of acute myeloid leukaemia and myelodysplastic syndrome have been reported in association with docetaxel when used in combination with other chemotherapy agents and/or radiotherapy.

Blood and lymphatic system disorders
Bone marrow suppression and other haematologic adverse reactions have been reported. Disseminated intravascular coagulation (DIC), often in association with sepsis or multiorgan failure, has been reported.

Immune system disorders
Some cases of anaphylactic shock, sometimes fatal, have been reported.

Hypersensitivity reactions (frequency not known) have been reported with docetaxel in patients who previously experienced hypersensitivity reactions to paclitaxel.

Nervous system disorders
Rare cases of convulsion or transient loss of consciousness have been observed with docetaxel administration. These reactions sometimes appear during the infusion of the medicinal product.

Eye disorders
Very rare cases of transient visual disturbances (flashes, flashing lights, scotomata) typically occurring during infusion of the medicinal product and in association with hypersensitivity reactions have been reported. These were reversible upon discontinuation of the infusion. Cases of lacrimation with or without conjunctivitis, as cases of lacrimal duct obstruction resulting in excessive tearing have been rarely reported. Cases of cystoid macular oedema (CMO) have been reported in patients treated with docetaxel.

Ear and labyrinth disorders
Rare cases of ototoxicity, hearing impaired and/or hearing loss have been reported.

Cardiac disorders
Rare cases of myocardial infarction have been reported.

Ventricular arrhythmia including ventricular tachycardia (frequency not known), sometimes fatal, has been reported in patients treated with docetaxel in combination regimens including doxorubicin, 5-fluorouracil and/ or cyclophosphamide.

Vascular disorders
Venous thromboembolic events have rarely been reported.

Respiratory, thoracic and mediastinal disorders
Acute respiratory distress syndrome, and cases of interstitial pneumonia / pneumonitis, interstitial lung disease, pulmonary fibrosis and respiratory failure sometimes fatal have rarely been reported. Rare cases of radiation pneumonitis have been reported in patients receiving concomitant radiotherapy.

Gastrointestinal disorders
Rare occurrences of dehydration as a consequence of gastrointestinal events, gastrointestinal perforation, colitis ischaemic, colitis and neutropenic enterocolitis have been reported. Rare cases of ileus and intestinal obstruction have been reported.

Hepatobiliary disorders
Very rare cases of hepatitis, sometimes fatal primarily in patients with pre-existing liver disorders, have been reported.

Skin and subcutaneous tissue disorders
Very rare cases of cutaneous lupus erythematosus and bullous eruptions such as erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, have been reported with docetaxel. In some cases concomitant factors may have contributed to the development of these effects. Sclerodermal-like changes usually preceded by peripheral lymphoedema have been reported with docetaxel. Cases of permanent alopecia have (frequency not known) been reported.

Renal and urinary disorders
Renal insufficiency and renal failure have been reported. In about 20% of these cases there were no risk factors for acute renal failure such as concomitant nephrotoxic medicinal products and gastrointestinal disorders.

General disorders and administration site conditions
Radiation recall phenomena have rarely been reported.

Injection site recall reaction (recurrence of skin reaction at a site of previous extravasation following administration of docetaxel at a different site) has been observed at the site of previous extravasation (frequency not known).

Fluid retention has not been accompanied by acute episodes of oliguria or hypotension. Dehydration and pulmonary oedema have rarely been reported.

Metabolism and nutrition disorders
Cases of electrolyte imbalance have been reported. Cases of hyponatraemia have been reported, mostly associated with dehydration, vomiting and pneumonia.

Hypokalaemia, hypomagnesaemia, and hypocalcaemia were observed, usually in association with gastrointestinal disorders and in particular with diarrhoea.

Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product.

4.9 Overdose
There were a few reports of overdose. There is no known antidote for docetaxel overdose. In case of overdose, the patient should be kept in a specialised unit and vital functions closely monitored. In cases of overdose, exacerbation of adverse events may be expected. The primary anticipated complications of overdose would consist of bone marrow suppression, peripheral neurotoxicity and mucositis. Patients should receive therapeutic G-CSF as soon as possible after discovery of overdose. Other appropriate symptomatic measures should be taken, as needed.

5. Pharmacological properties

5.1 Pharmacodynamic properties

Pharmacotherapeutic group: Taxanes,
Mechanism of action

Docetaxel is an antineoplastic agent which acts by promoting the assembly of tubulin into stable microtubules and inhibits their disassembly which leads to a marked decrease of free tubulin. The binding of docetaxel to microtubules does not alter the number of protofilaments.

Docetaxel has been shown?in vitro?to disrupt the microtubular network in cells which is essential for vital mitotic and interphase cellular functions.

Pharmacodynamic effects

Docetaxel was found to be cytotoxic?in vitro?against various murine and human tumour cell lines and against freshly excised human tumour cells in clonogenic assays. Docetaxel achieves high intracellular concentrations with a long cell residence time. In addition, docetaxel was found to be active on some but not all cell lines over expressing the p glycoprotein which is encoded by the multidrug resistance gene.?In vivo, docetaxel is schedule independent and has a broad spectrum of experimental antitumour activity against advanced murine and human grafted tumours.

Clinical efficacy and safety

Breast cancer

Docetaxel in combination with doxorubicin and cyclophosphamide: adjuvant therapy

Patients with operable node-positive breast cancer (TAX 316)

Data from a multicenter open label randomized study support the use of docetaxel for the adjuvant treatment of patients with operable node-positive breast cancer and KPS ? 80%, between 18 and 70 years of age. After stratification according to the number of positive lymph nodes (1-3, 4+), 1491 patients were randomized to receive either docetaxel 75 mg/m2?administered 1-hour after doxorubicin 50 mg/m2?and cyclophosphamide 500 mg/m2?(TAC arm), or doxorubicin 50 mg/m2?followed by fluorouracil 500 mg/m2?and cyclosphosphamide 500 mg/m2?(FAC arm). Both regimens were administered once every 3 weeks for 6 cycles. Docetaxel was administered as a 1-hour infusion, all other medicinal products were given as intravenous bolus on day one. G CSF was administered as secondary prophylaxis to patients who experienced complicated neutropenia (febrile neutropenia, prolonged neutropenia, or infection). Patients on the TAC arm received antibiotic prophylaxis with ciprofloxacin 500 mg orally twice daily for 10 days starting on day 5 of each cycle, or equivalent. In both arms, after the last cycle of chemotherapy, patients with positive estrogen and/or progesterone receptors received tamoxifen 20 mg daily for up to 5 years. Adjuvant radiation therapy was prescribed according to guidelines in place at participating institutions and was given to 69% of patients who received TAC and 72% of patients who received FAC.

Two interim analyses and one final analysis were performed. The first interim analysis was planned 3 years after the date when half of study enrolment was done. The second interim analysis was done after 400 DFS events had been recorded overall, which led to a median follow up of 55 months. The final analysis was performed when all patients had reached their 10-year follow-up visit (unless they had a DFS event or were lost to follow-up before) Disease-free survival (DFS) was the primary efficacy endpoint and Overall survival (OS) was the secondary efficacy endpoint.

A final analysis was performed with an actual median follow up of 96 months. Significantly longer disease-free survival for the TAC arm compared to the FAC arm was demonstrated. Incidence of relapses at 10 years was reduced in patients receiving TAC compared to those who received FAC (39% versus 45%, respectively) i.e. an absolute risk reduction by 6% (p = 0.0043). Overall survival at 10 years was also significantly increased with TAC compared to FAC (76% versus 69%, respectively) i.e. an absolute reduction of the risk of death by 7% (p = 0.002). As the benefit observed in patients with 4+ nodes was not statistically significant on DFS and OS, the positive benefit/risk ratio for TAC in patients with 4+ nodes was not fully demonstrated at the final analysis.

Overall, the study results demonstrate a positive benefit risk ratio for TAC compared to FAC.

TAC-treated patient subsets according to prospectively defined major prognostic factors were analyzed:

Disease free survivalOverall survival
Patient subsetNumber of patientsHazard ratio*95% CIp =Hazard ratio*95% CIp =
No of positive nodes
Overall7450.800.68-0.930.00430.740.61-0.900.0020
1-34670.720.58-0.910.00470.620.46-0.820.0008
4+2780.870.70-1.090.22900.870.67-1.120.2746

*a hazard ratio of less than 1 indicates that TAC is associated with a longer disease-free survival and overall survival compared to FAC

Patients with operable node-negative breast cancer eligible to receive chemotherapy (GEICAM 9805)

Data from a multicenter open label randomized trial support the use of docetaxel for the adjuvant treatment of patients with operable node-negative breast cancer eligible to receive chemotherapy.

1060 patients were randomized to receive either docetaxel 75 mg/m2?administered 1-hour after doxorubicin 50 mg/m2?and cyclophosphamide 500 mg/m2?(539 patients in TAC arm), or doxorubicin 50 mg/m2?followed by fluorouracil 500 mg/m2?and cyclosphosphamide 500 mg/m2?(521 patients in FAC arm), as adjuvant treatment of operable node-negative breast cancer patients with high risk of relapse according to 1998 St. Gallen criteria (tumour size >2 cm and/or negative ER and PR and/or high histological/nuclear grade (grade 2 to 3) and /or age <35 years). Both regimens were administered once every 3 weeks for 6 cycles. Docetaxel was administered as a 1-hour infusion, all other medicinal products were given intraveinously on day 1 every three weeks. Primary prophylactic G-CSF was made mandatory in TAC arm after 230 patients were randomized. The incidence of Grade 4 neutropenia, febrile neutropenia and neutropenic infection was decreased in patients who received primary G-CSF prophylaxis (see section 4.8). In both arms, after the last cycle of chemotherapy, patients with ER+ and/or PgR+ tumours received tamoxifen 20 mg once a day for up to 5 years. Adjuvant radiation therapy was administered according to guidelines in place at participating institutions and was given to 57.3% of patients who received TAC and 51.2% of patients who received FAC.

One primary analysis and one updated analysis were performed. The primary analysis was done when all patients had a follow-up of greater than 5 years (median follow-up time of 77 months). The updated analysis was performed when all patients had reached their 10-year (median follow up time of 10 years and 5 months) follow-up visit (unless they had a DFS event or were lost to follow-up previously). Disease-free survival (DFS) was the primary efficacy endpoint and Overall survival (OS) was the secondary efficacy endpoint.

At the median follow-up time of 77 months, significantly longer disease-free survival for the TAC arm compared to the FAC arm was demonstrated. TAC-treated patients had a 32% reduction in the risk of relapse compared to those treated with FAC (hazard ratio = 0.68, 95% CI (0.49-0.93), p = 0.01). At the median follow up time of 10 years and 5 months, TAC-treated patients had a 16,5% reduction in the risk of relapse compared to those treated with FAC (hazard ratio = 0.84, 95% CI (0.65-1.08), p=0.1646). DFS data were not statistically significant but were still associated with a positive trend in favour of TAC.

At the median follow-up time of 77 months, overall survival (OS) was longer in the TAC arm with TAC-treated patients having a 24% reduction in the risk of death compared to FAC (hazard ratio = 0.76, 95% CI (0.46-1.26, p = 0.29). However, the distribution of OS was not significantly different between the 2 groups.

At the median follow up time of 10 years and 5 months, TAC-treated patients had a 9% reduction in the risk of death compared to FAC-treated patients (hazard ratio = 0.91, 95% CI (0.63-1.32)). The survival rate was 93.7% in the TAC arm and 91.4 % in the FAC arm, at the 8-year follow-up timepoint, and 91.3 % in the TAC arm and 89 % in the FAC arm, at the 10-year follow-up timepoint.

The positive benefit risk ratio for TAC compared to FAC remained unchanged.

TAC-treated patient subsets according to prospectively defined major prognostic factors were analyzed in the primary analysis (at the median follow-up time of 77 months) (see table below):

Subset Analyses-Adjuvant Therapy in Patients with Node-negative Breast Cancer Study (Intent-to-Treat Analysis)

Patient subsetNumber of patients in TAC groupDisease Free Survival
Hazard ratio*95% CI
Overall5390.680.49-0.93
Age category 1<50 years

?50 years

260

279

0.67

0.67

0.43-1.05

0.43-1.05

Age category 2<35 years

?35 years

42

497

0.31

0.73

0.11-0.89

0.52-1.01

Hormonal receptor statusNegative

Positive

195

344

0.7

0.62

0.45-1.1

0.4-0.97

Tumour size?2 cm

>2 cm

285

254

0.69

0.68

0.43-1.1

0.45-1.04

Histological gradeGrade1 (includes grade not assessed)

Grade 2

Grade 3

64

216

259

0.79

0.77

0.59

0.24-2.6

0.46-1.3

0.39-0.9

Menopausal statusPre-Menopausal

Post-Menopausal

285

254

0.64

0.72

0.40-1

0.47-1.12

*a hazard ratio (TAC/FAC) of less than 1 indicates that TAC is associated with a longer disease free survival compared to FAC.

Exploratory subgroup analyses for disease-free survival for patients who meet the 2009 St. Gallen chemotherapy criteria ? (ITT population) were performed and presented here below

SubgroupsTAC(n=539)FAC(n=521)Hazard ratio(TAC/FAC)

(95% CI)

p-value
Meeting relative indication for chemotherapya
No18/21426/2270.796 (0.434 ? 1.459)0.4593
(8.4%)(11.5%)
Yes48/32569/2940.606 (0.42 ? 0.877)0.0072
(14.8%)(23.5%)

TAC = docetaxel, doxorubicin and cyclophosphamide

FAC = 5-fluorouracil, doxorubicin and cyclophospamide

CI = confidence interval; ER = estrogen receptor

PR = progesterone receptor

a?ER/PR-negative or Grade 3 or tumour size >5 cm

The estimated hazard ratio was using Cox proportional hazard model with treatment group as the factor.

Docetaxel as single agent

Two randomised phase III comparative studies, involving a total of 326 alkylating or 392 anthracycline failure metastatic breast cancer patients, have been performed with docetaxel at the recommended dose and regimen of 100 mg/m? every 3 weeks.

In alkylating-failure patients, docetaxel was compared to doxorubicin (75 mg/m? every 3 weeks). Without affecting overall survival time (docetaxel 15 months vs. doxorubicin 14 months, p = 0.38) or time to progression (docetaxel 27 weeks vs. doxorubicin 23 weeks, p = 0.54), docetaxel increased response rate (52% vs. 37%, p = 0.01) and shortened time to response (12 weeks vs. 23 weeks, p = 0.007). Three docetaxel patients (2%) discontinued the treatment due to fluid retention, whereas 15 doxorubicin patients (9%) discontinued due to cardiac toxicity (three cases of fatal congestive heart failure).

In anthracycline-failure patients, docetaxel was compared to the combination of mitomycin C and vinblastine (12 mg/m? every 6 weeks and 6 mg/m? every 3 weeks). Docetaxel increased response rate (33% vs. 12%, p < 0.0001), prolonged time to progression (19 weeks vs. 11 weeks, p = 0.0004) and prolonged overall survival (11 months vs. 9 months, p = 0.01).

During these two phase III studies, the safety profile of docetaxel was consistent with the safety profile observed in phase II studies (see section 4.8).

An open-label, multicenter, randomized phase III study was conducted to compare docetaxel monotherapy and paclitaxel in the treatment of advanced breast cancer in patients whose previous therapy should have included an anthracycline. A total of 449 patients were randomized to receive either docetaxel monotherapy 100 mg/m? as a 1 hour infusion or paclitaxel 175 mg/m? as a 3 hour infusion. Both regimens were administered every 3 weeks.

Without affecting the primary endpoint, overall response rate (32% vs 25%, p = 0.10), docetaxel prolonged median time to progression (24.6 weeks vs 15.6 weeks; p < 0.01) and median survival (15.3 months vs 12.7 months; p = 0.03).

More grade 3/4 adverse events were observed for docetaxel monotherapy (55.4%) compared to paclitaxel (23.0%).

Docetaxel in combination with doxorubicin

One large randomized phase III study, involving 429 previously untreated patients with metastatic disease, has been performed with doxorubicin (50 mg/m?) in combination with docetaxel (75 mg/m?) (AT arm) versus doxorubicin (60 mg/m?) in combination with cyclophosphamide (600 mg/m?) (AC arm). Both regimens were administered on day 1 every 3 weeks.

  • Time to progression (TTP) was significantly longer in the AT arm versus AC arm, p = 0.0138. The median TTP was 37.3 weeks (95% CI: 33.4 42.1) in AT arm and 31.9 weeks (95% CI: 27.4 ? 36.0) in AC arm.
  • Overall response rate (ORR) was significantly higher in the AT arm versus AC arm, p = 0.009. The ORR was 59.3% (95% CI: 52.8 ? 65.9) in AT arm versus 46.5% (95% CI: 39.8 ? 53.2) in AC arm.

In this study, AT arm showed a higher incidence of severe neutropenia (90% versus 68.6%), febrile neutropenia (33.3% versus 10%), infection (8% versus 2.4%), diarrhoea (7.5% versus 1.4%), asthenia (8.5% versus 2.4%), and pain (2.8% versus 0%) than AC arm. On the other hand, AC arm showed a higher incidence of severe anaemia (15.8% versus 8.5%) than AT arm, and, in addition, a higher incidence of severe cardiac toxicity: congestive heart failure (3.8% versus 2.8%), absolute LVEF decrease ? 20% (13.1% versus 6.1%), absolute LVEF decrease ? 30% (6.2% versus 1.1%). Toxic deaths occurred in 1 patient in the AT arm (congestive heart failure) and in 4 patients in the AC arm (1 due to septic shock and 3 due to congestive heart failure).

In both arms, quality of life measured by the EORTC questionnaire was comparable and stable during treatment and follow up.

Docetaxel in combination with trastuzumab

Docetaxel in combination with trastuzumab was studied for the treatment of patients with metastatic breast cancer whose tumours overexpress HER2, and who previously had not received chemotherapy for metastatic disease. One hundred eighty six patients were randomized to receive docetaxel (100 mg/m2) with or without trastuzumab; 60% of patients received prior anthracycline-based adjuvant chemotherapy. Docetaxel plus trastuzumab was efficacious in patients whether or not they had received prior adjuvant anthracyclines. The main test method used to determine HER2 positivity in this pivotal study was immunohistochemistry (IHC). A minority of patients were tested using fluorescence in situ hybridization (FISH). In this study, 87% of patients had disease that was IHC 3+, and 95% of patients entered had disease that was IHC 3+ and/or FISH positive. Efficacy results are summarized in the following table:

ParameterDocetaxel plus trastuzumab1n = 92Docetaxel1n = 94
Response rate(95% CI)61%(50-71)34%(25-45)
Median duration of response (months)(95% CI)11.4(9.2-15.0)5.1(4.4-6.2)
Median TTP (months)(95% CI)10.6(7.6-12.9)5.7(5.0-6.5)
Median survival (months)(95% CI)30.52(26.8-ne)22.12(17.6-28.9)

TTP = time to progression; ?ne? indicates that it could not be estimated or it was not yet reached.

1Full analysis set (intent-to-treat)

2?Estimated median survival

Docetaxel in combination with capecitabine

Data from one multicenter, randomised, controlled phase III clinical study support the use of docetaxel in combination with capecitabine for treatment of patients with locally advanced or metastatic breast cancer after failure of cytotoxic chemotherapy, including an anthracycline. In this study, 255 patients were randomised to treatment with docetaxel (75 mg/m2?as a 1 hour intravenous infusion every 3 weeks) and capecitabine (1250 mg/m2?twice daily for 2 weeks followed by 1-week rest period). 256 patients were randomised to treatment with docetaxel alone (100 mg/m2?as a 1 hour intravenous infusion every 3 weeks). Survival was superior in the docetaxel + capecitabine combination arm (p = 0.0126). Median survival was 442 days (docetaxel + capecitabine) vs. 352 days (docetaxel alone). The overall objective response rates in the all randomised population (investigator assessment) were 41.6% (docetaxel + capecitabine) vs. 29.7% (docetaxel alone); p = 0.0058. Time to progressive disease was superior in the docetaxel + capecitabine combination arm (p < 0.0001). The median time to progression was 186 days (docetaxel + capecitabine) vs. 128 days (docetaxel alone).

Non-small cell lung cancer

Patients previously treated with chemotherapy with or without radiotherapy

In a phase III study, in previously treated patients, time to progression (12.3 weeks versus 7 weeks) and overall survival were significantly longer for docetaxel at 75 mg/m? compared to Best Supportive Care. The 1 year survival rate was also significantly longer in docetaxel (40%) versus BSC (16%).

There was less use of morphinic analgesic (p < 0.01), non-morphinic analgesics (p < 0.01), other disease-related medicinal products (p = 0.06) and radiotherapy (p < 0.01) in patients treated with docetaxel at 75 mg/m? compared to those with BSC.

The overall response rate was 6.8% in the evaluable patients, and the median duration of response was 26.1 weeks.

Docetaxel in combination with platinum agents in chemotherapy-na?ve patients

In a phase III study, 1218 patients with unresectable stage IIIB or IV NSCLC, with KPS of 70% or greater, and who did not receive previous chemotherapy for this condition, were randomised to either docetaxel (T) 75 mg/m2?as a 1 hour infusion immediately followed by cisplatin (Cis) 75 mg/m2?over 30 60 minutes every 3 weeks (TCis), docetaxel 75 mg/m2?as a 1 hour infusion in combination with carboplatin (AUC 6 mg/ml.min) over 30 60 minutes every 3 weeks, or vinorelbine (V) 25 mg/m2?administered over 6 10 minutes on days 1, 8, 15, 22 followed by cisplatin 100 mg/m2?administered on day 1 of cycles repeated every 4 weeks (VCis).

Survival data, median time to progression and response rates for two arms of the study are illustrated in the following table:

TCisn = 408VCisn = 404Statistical analysis
Overall survival(Primary end-point):
Median survival (months)11.310.1Hazard ratio: 1.122[97.2% CI: 0.937; 1.342]*
1-year Survival (%)4641Treatment difference: 5.4%[95% CI: -1.1; 12.0]
2-year Survival (%)2114Treatment difference: 6.2%[95% CI: 0.2; 12.3]
Median time to progression(weeks):22.023.0Hazard ratio: 1.032[95% CI: 0.876; 1.216]
Overall response rate (%):31.624.5Treatment difference: 7.1%[95% CI: 0.7; 13.5]

*: Corrected for multiple comparisons and adjusted for stratification factors (stage of disease and region of treatment), based on evaluable patient population.

Secondary end points included change of pain, global rating of quality of life by EuroQoL-5D, Lung Cancer Symptom Scale, and changes in Karnosfky performance status. Results on these end-points were supportive of the primary end-points results.

For docetaxel/carboplatin combination, neither equivalent nor non-inferior efficacy could be proven compared to the reference treatment combination VCis.

Prostate cancer

The safety and efficacy of docetaxel in combination with prednisone or prednisolone in patients with hormone refractory metastatic prostate cancer were evaluated in a randomized multicenter phase III study. A total of 1006 patients with KPS ? 60 were randomized to the following treatment groups:

  • Docetaxel 75 mg/m2every 3 weeks for 10 cycles.
  • Docetaxel 30 mg/m2administered weekly for the first 5 weeks in a 6 week cycle for 5 cycles.
  • Mitoxantrone 12 mg/m2every 3 weeks for 10 cycles.

All 3 regimens were administered in combination with prednisone or prednisolone 5 mg twice daily, continuously.

Patients who received docetaxel every three weeks demonstrated significantly longer overall survival compared to those treated with mitoxantrone. The increase in survival seen in the docetaxel weekly arm was not statistically significant compared to the mitoxantrone control arm. Efficacy endpoints for the docetaxel arms versus the control arm are summarized in the following table:

EndpointDocetaxelevery 3 weeksDocetaxelevery weekMitoxantroneevery 3 weeks
Number of patientsMedian survival (months)

95% CI

Hazard ratio

95% CI

p-value?*

33518.9

(17.0-21.2)

0.761

(0.619-0.936)

0.0094

33417.4

(15.7-19.0)

0.912

(0.747-1.113)

0.3624

33716.5

(14.4-18.6)

?

?

?

Number of patientsPSA** response rate (%)

95% CI

p-value*

29145.4

(39.5-51.3)

0.0005

28247.9

(41.9-53.9)

<0.0001

30031.7

(26.4-37.3)

?-

Number of patientsPain response rate (%)

95% CI

p-value*

15334.6

(27.1-42.7)

0.0107

15431.2

(24.0-39.1)

0.0798

15721.7

(15.5-28.9)

?

Number of patientsTumour response rate (%)

95% CI

p-value*

14112.1

(7.2-18.6)

0.1112

1348.2

(4.2-14.2)

0.5853

1376.6

(3.0-12.1)

?

?Stratified log rank test

*Threshold for statistical significance = 0.0175

**PSA: Prostate-Specific Antigen

Given the fact that docetaxel every week presented a slightly better safety profile than docetaxel every 3 weeks, it is possible that certain patients may benefit from docetaxel every week.

No statistical differences were observed between treatment groups for Global Quality of Life.

Gastric adenocarcinoma

A multicenter, open-label, randomized study was conducted to evaluate the safety and efficacy of docetaxel for the treatment of patients with metastatic gastric adenocarcinoma, including adenocarcinoma of the gastroesophageal junction, who had not received prior chemotherapy for metastatic disease. A total of 445 patients with KPS > 70 were treated with either docetaxel (T) (75 mg/m2?on day 1) in combination with cisplatin (C) (75 mg/m2?on day 1) and 5-fluorouracil (F) (750 mg/m2?per day for 5 days) or cisplatin (100 mg/m2 on day 1) and 5 fluorouracil (1000 mg/m2?per day for 5 days). The length of a treatment cycle was 3 weeks for the TCF arm and 4 weeks for the CF arm. The median number of cycles administered per patient was 6 (with a range of 1-16) for the TCF arm compared to 4 (with a range of 1-12) for the CF arm. Time to progression (TTP) was the primary endpoint. The risk reduction of progression was 32.1% and was associated with a significantly longer TTP (p = 0.0004) in favor of the TCF arm. Overall survival was also significantly longer (p = 0.0201) in favor of the TCF arm with a risk reduction of mortality of 22.7%. Efficacy results are summarized in the following table:

Efficacy of docetaxel in the treatment of patients with gastric adenocarcinoma

EndpointTCFn = 221CFn = 224
Median TTP (months)5.63.7
(95% CI)(4.86-5.91)(3.45-4.47)
Hazard ratio1.473
(95% CI)(1.189-1.825)
*p-value0.0004
Median survival (months)9.28.6
(95% CI)(8.38-10.58)(7.16-9.46)
2-year estimate (%)18.48.8
Hazard ratio1.293
(95% CI)(1.041-1.606)
*p-value0.0201
Overall response rate (CR+PR) (%)36.725.4
p-value0.0106
Progressive disease as best overall response (%)16.725.9

*Unstratified logrank test

Subgroup analyses across age, gender and race consistently favored the TCF arm compared to the CF arm.

A survival update analysis conducted with a median follow-up time of 41.6 months no longer showed a statistically significant difference although always in favour of the TCF regimen and showed that the benefit of TCF over CF is clearly observed between 18 and 30 months of follow up.

Overall, quality of life (QoL) and clinical benefit results consistently indicated improvement in favor of the TCF arm. Patients treated with TCF had a longer time to 5% definitive deterioration of global health status on the QLQ C30 questionnaire (p = 0.0121) and a longer time to definitive worsening of Karnofsky performance status (p = 0.0088) compared to patients treated with CF.

Head and neck cancer

  • Induction chemotherapy followed by radiotherapy (TAX323)

The safety and efficacy of docetaxel in the induction treatment of patients with squamous cell carcinoma of the head and neck (SCCHN) was evaluated in a phase III, multicenter, open-label, randomized study (TAX323). In this study, 358 patients with inoperable locally advanced SCCHN, and WHO perfomance status 0 or 1, were randomized to one of two treatment arms. Patients on the docetaxel arm received docetaxel (T) 75 mg/m2?followed by cisplatin (P) 75 mg/m2?followed by 5 fluorouracil (F) 750 mg/m2?per day as a continuous infusion for 5 days. This regimen was administered every three weeks for 4 cycles in case at least a minor response (? 25% reduction in bidimensionally measured tumour size) was observed after 2 cycles. At the end of chemotherapy, with a minimal interval of 4 weeks and a maximal interval of 7 weeks, patients whose disease did not progress received radiotherapy (RT) according to institutional guidelines for 7 weeks (TPF/RT). Patients on the comparator arm received cisplatin (P) 100 mg/m2 followed by 5 fluorouracil (F) 1000 mg/m2?per day for 5 days. This regimen was administered every three weeks for 4 cycles in case at least a minor response (? 25% reduction in bidimensionally measured tumour size) was observed after 2 cycles. At the end of chemotherapy, with a minimal interval of 4 weeks and a maximal interval of 7 weeks, patients whose disease did not progress received radiotherapy (RT) according to institutional guidelines for 7 weeks (PF/RT). Locoregional therapy with radiation was delivered either with a conventional fraction (1.8 Gy ? 2.0 Gy once a day, 5 days per week for a total dose of 66 to 70 Gy), or accelerated/hyperfractionated regimens of radiation therapy (twice a day, with a minimum interfraction interval of 6 hours, 5 days per week). A total of 70 Gy was recommended for accelerated regimens and 74 Gy for hyperfractionated schemes. Surgical resection was allowed following chemotherapy, before or after radiotherapy. Patients on the TPF arm received antibiotic prophylaxis with ciprofloxacin 500 mg orally twice daily for 10 days starting on day 5 of each cycle, or equivalent. The primary endpoint in this study, progression-free survival (PFS), was significantly longer in the TPF arm compared to the PF arm, p = 0.0042 (median PFS: 11.4 vs. 8.3 months respectively) with an overall median follow up time of 33.7 months. Median overall survival was also significantly longer in favor of the TPF arm compared to the PF arm (median OS: 18.6 vs. 14.5 months respectively) with a 28% risk reduction of mortality, p = 0.0128. Efficacy results are presented in the table below:

Efficacy of docetaxel in the induction treatment of patients with inoperable locally advanced SCCHN (Intent-to-Treat Analysis)

ENDPOINTDocetaxel + Cis + 5-FUn = 177Cis + 5-FUn = 181
Median progression free survival (months)(95% CI)11.4(10.1-14.0)8.3(7.4-9.1)
Adjusted hazard ratio(95% CI)

*p-value

0.70(0.55-0.89)

0.0042

Median survival (months)(95% CI)18.6(15.7-24.0)14.5(11.6-18.7)
Hazard ratio(95% CI)

**p-value

0.72(0.56-0.93)

0.0128

Best overall response to chemotherapy (%)(95% CI)67.8(60.4-74.6)53.6(46.0-61.0)
***p-value0.006
Best overall response to study treatment [chemotherapy +/- radiotherapy] (%)(95% CI)72.3(65.1-78.8)58.6(51.0-65.8)
***p-value0.006
Median duration of response to chemotherapy ? radiotherapy (months)(95% CI)n = 12815.7

(13.4-24.6)

n = 10611.7

(10.2-17.4)

Hazard ratio(95% CI)

**p-value

0.72(0.52-0.99)

0.0457

A hazard ratio of less than 1 favors docetaxel + cisplatin + 5-FU

*Cox model (adjustment for Primary tumour site, T and N clinical stages and PSWHO)

**Logrank test

*** Chi-square test

Quality of life parameters

Patients treated with TPF experienced significantly less deterioration of their Global health score compared to those treated with PF (p = 0.01, using the EORTC QLQ C30 scale).

Clinical benefit parameters

The performance status scale, for head and neck (PSS-HN) subscales designed to measure understandability of speech, ability to eat in public, and normalcy of diet, was significantly in favor of TPF as compared to PF.

Median time to first deterioration of WHO performance status was significantly longer in the TPF arm compared to PF. Pain intensity score improved during treatment in both groups indicating adequate pain management.

  • Induction chemotherapy followed by chemoradiotherapy (TAX324)

The safety and efficacy of docetaxel in the induction treatment of patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) was evaluated in a randomized, multicenter open-label, phase III study (TAX324). In this study, 501 patients, with locally advanced SCCHN, and a WHO performance status of 0 or 1, were randomized to one of two arms. The study population comprised patients with technically unresectable disease, patients with low probability of surgical cure and patients aiming at organ preservation. The efficacy and safety evaluation solely addressed survival endpoints and the success of organ preservation was not formally addressed. Patients on the docetaxel arm received docetaxel (T) 75 mg/m? by intravenous infusion on day 1 followed by cisplatin (P) 100 mg/m? administered as a 30 minute to three-hour intravenous infusion, followed by the continuous intravenous infusion of 5 fluorouracil (F) 1000 mg/m?/day from day 1 to day 4. The cycles were repeated every 3 weeks for 3 cycles. All patients who did not have progressive disease were to receive chemoradiotherapy (CRT) as per protocol (TPF/CRT). Patients on the comparator arm received cisplatin (P) 100 mg/m? as a 30 minute to three hour intravenous infusion on day 1 followed by the continuous intravenous infusion of 5 fluorouracil (F) 1000 mg/m?/day from day 1 to day 5. The cycles were repeated every 3 weeks for 3 cycles. All patients who did not have progressive disease were to receive CRT as per protocol (PF/CRT).

Patients in both treatment arms were to receive 7 weeks of CRT following induction chemotherapy with a minimum interval of 3 weeks and no later than 8 weeks after start of the last cycle (day 22 to day 56 of last cycle). During radiotherapy, carboplatin (AUC 1.5) was given weekly as a one hour intravenous infusion for a maximum of 7 doses. Radiation was delivered with megavoltage equipment using once daily fractionation (2 Gy per day, 5 days per week for 7 weeks, for a total dose of 70 ? 72 Gy). Surgery on the primary site of disease and/or neck could be considered at anytime following completion of CRT. All patients on the docetaxel-containing arm of the study received prophylactic antibiotics. The primary efficacy endpoint in this study, overall survival (OS) was significantly longer (log-rank test, p = 0.0058) with the docetaxel-containing regimen compared to PF (median OS: 70.6 versus 30.1 months respectively), with a 30% risk reduction in mortality compared to PF (hazard ratio (HR) = 0.70, 95% confidence interval (CI) = 0.54 ? 0.90) with an overall median follow up time of 41.9 months. The secondary endpoint, PFS, demonstrated a 29% risk reduction of progression or death and a 22 month improvement in median PFS (35.5 months for TPF and 13.1 for PF). This was also statistically significant with an HR of 0.71; 95% CI 0.56-0.90; log-rank test p = 0.004. Efficacy results are presented in the table below:

Efficacy of docetaxel in the induction treatment of patients with locally advanced SCCHN (Intent-to-Treat Analysis)

EndpointDocetaxel + Cis + 5-FUn = 255Cis + 5-FUn = 246
Median overall survival (months)(95% CI)70.6(49.0-NA)30.1(20.9-51.5)
Hazard ratio:(95% CI)

*p-value

0.70(0.54-0.90)

0.0058

Median PFS (months)(95% CI)35.5(19.3-NA)13.1(10.6 ? 20.2)
Hazard ratio:(95% CI)

**p-value

0.71(0.56 ? 0.90)

0.004

Best overall response (CR + PR) to chemotherapy (%)(95% CI)71.8(65.8-77.2)64.2(57.9-70.2)
***p-value0.070
Best overall response (CR + PR) to study treatment [chemotherapy +/- chemoradiotherapy] (%)(95%CI)76.5(70.8-81.5)71.5(65.5-77.1)
***p-value0.209

A hazard ratio of less than 1 favors docetaxel + cisplatin + fluorouracil

*un-adjusted log-rank test

**un-adjusted log-rank test, not adjusted for multiple comparisons

***Chi square test, not adjusted for multiple comparisons

NA-not applicable

Paediatric population

The European Medicines Agency has waived the obligation to submit the results of studies with docetaxel in all subsets of the paediatric population in breast cancer, non-small cell lung cancer, prostate cancer, gastric carcinoma and head and neck cancer, not including type II and III less differentiated nasopharyngeal carcinoma (see section 4.2 for information on paediatric use).

5.2 Pharmacokinetic properties

Absorption
The pharmacokinetics of docetaxel have been evaluated in cancer patients after administration of 20-115 mg/m2?in phase I studies. The kinetic profile of docetaxel is dose independent and consistent with a three-compartment pharmacokinetic model with half lives for the ?, ? and ? phases of 4 min, 36 min and 11.1 h, respectively. The late phase is due, in part, to a relatively slow efflux of docetaxel from the peripheral compartment.

Distribution
Following the administration of a 100 mg/m2?dose given as a one-hour infusion a mean peak plasma level of 3.7 ?g/ml was obtained with a corresponding AUC of 4.6 h.?g/ml. Mean values for total body clearance and steady-state volume of distribution were 21 l/h/m2 and 113 l, respectively. Inter individual variation in total body clearance was approximately 50%. Docetaxel is more than 95% bound to plasma proteins.

Elimination
A study of?14C docetaxel has been conducted in three cancer patients. Docetaxel was eliminated in both the urine and faeces following cytochrome P450 mediated oxidative metabolism of the tert-butyl ester group, within seven days, the urinary and faecal excretion accounted for about 6% and 75% of the administered radioactivity, respectively. About 80% of the radioactivity recovered in faeces is excreted during the first 48 hours as one major inactive metabolite and 3 minor inactive metabolites and very low amounts of unchanged medicinal product.

Special populations

Age and gender
A population pharmacokinetic analysis has been performed with docetaxel in 577 patients. Pharmacokinetic parameters estimated by the model were very close to those estimated from phase I studies. The pharmacokinetics of docetaxel were not altered by the age or sex of the patient.

Hepatic impairment
In a small number of patients (n = 23) with clinical chemistry data suggestive of mild to moderate liver function impairment (ALT, AST ? 1.5 times the ULN associated with alkaline phosphatase ? 2.5 times the ULN), total clearance was lowered by 27% on average (see section 4.2).

Fluid retention
Docetaxel clearance was not modified in patients with mild to moderate fluid retention and there are no data available in patients with severe fluid retention.

Combination therapy

Doxorubicin
When used in combination, docetaxel does not influence the clearance of doxorubicin and the plasma levels of doxorubicinol (a doxorubicin metabolite). The pharmacokinetics of docetaxel, doxorubicin and cyclophosphamide were not influenced by their co-administration.

Capecitabine
Phase I study evaluating the effect of capecitabine on the pharmacokinetics of docetaxel and vice versa showed no effect by capecitabine on the pharmacokinetics of docetaxel (Cmax and AUC) and no effect by docetaxel on the pharmacokinetics of a relevant capecitabine metabolite 5?-DFUR.

Cisplatin
Clearance of docetaxel in combination therapy with cisplatin was similar to that observed following monotherapy. The pharmacokinetic profile of cisplatin administered shortly after docetaxel infusion is similar to that observed with cisplatin alone.

Cisplatin and 5-fluorouracil
The combined administration of docetaxel, cisplatin and 5-fluorouracil in 12 patients with solid tumours had no influence on the pharmacokinetics of each individual medicinal product.

Prednisone and dexamethasone
The effect of prednisone on the pharmacokinetics of docetaxel administered with standard dexamethasone premedication has been studied in 42 patients.

Prednisone
No effect of prednisone on the pharmacokinetics of docetaxel was observed.

5.3 Preclinical safety data
The carcinogenic potential of docetaxel has not been studied.

Docetaxel has been shown to be mutagenic in the?in vitro?micronucleus and chromosome aberration test in CHO K1 cells and in the?in vivo?micronucleus test in the mouse. However, it did not induce mutagenicity in the Ames test or the CHO/HGPRT gene mutation assay. These results are consistent with the pharmacological activity of docetaxel.

Undesirable effects on the testis observed in rodent toxicity studies suggest that docetaxel may impair male fertility.

6. Pharmaceutical particulars

6.1 List of excipients

Polysorbate 80
Ethanol anhydrous
Citric acid

6.2 Incompatibilities

This medicinal product must not be mixed with other medicinal products except those mentioned in section 6.6.

6.3 Shelf life

Unopened Vial
24 months

After opening of the vial
Each vial is for single use and should be used immediately after opening. If not used immediately, in-use storage times and conditions are the responsibility of the user.

Once added to the infusion bag

From microbiological point of view, reconstitution/dilution must take place in controlled and aseptic conditions and the medicinal product should be used immediately. If not used immediately, in use storage times and conditions are the responsibility of the user.

Once added as recommended into the infusion bag (PP) or infusion bottle (PE), the docetaxel infusion solution, if stored below 25?C, is stable for 8 hours in infusion bottle or for 6 hours in infusion bag. It should be used within 6-8 hours (including the one hour infusion IV administration).

In addition, physical and chemical in-use stability of the infusion solution prepared as recommended has been demonstrated in non-PVC bags up to 48 hours when stored between 2 to 8?C.

Docetaxel infusion solution is supersaturated, therefore may crystallize over time. If crystals appear, the solution must no longer be used and shall be discarded.

6.4 Special precautions for storage

Do not store above 25?C.

Store in the original package in order to protect from light.

For storage conditions of the diluted medicinal product, see section 6.3.

6.5 Nature and contents of container

6 ml colourless type-I glass vial, closed with a 20 mm grey chlorobutyl rubber stopper and a green flip-off seal consisting of an aluminium shell and a green plastic flip-off button. The rubber stopper is coated with a Teflon??barrier film.

Each box contains one vial with 1 ml fill volume

6 ml colourless type-I glass vial, closed with a 20 mm grey chlorobutyl rubber stopper and an orange flip-off seal consisting of an aluminium shell and an orange plastic flip-off button. The rubber stopper is coated with a Teflon? barrier film.

Each box contains one vial with 4 ml fill volume.

15 ml colourless type-I glass vial, closed with a 20 mm grey chlorobutyl rubber stopper and a red flip-off seal consisting of an aluminium shell and a red plastic flip-off button. The rubber stopper is coated with a Teflon? barrier film.

Each box contains one vial with 8 ml fill volume.

6.6 Special precautions for disposal and other handling

Docetaxel is an antineoplastic agent and, as with other potentially toxic compounds, caution should be exercised when handling it and preparing Docetaxel solutions. The use of gloves is recommended.

If Docetaxel concentrate or infusion solution should come into contact with skin, wash immediately and thoroughly with soap and water. If Docetaxel concentrate or infusion solution should come into contact with mucous membranes, wash immediately and thoroughly with water.

Preparation for the intravenous administration

Preparation of the infusion solution

DO NOT use other docetaxel medicinal products consisting of more than one vial (concentrate and solvent) with this medicinal product (Docetaxel 20 mg/ml concentrate for solution for infusion, which contains only 1 vial).

Docetaxel 20 mg/ml concentrate for solution for infusion requires NO prior dilution with a solvent and is ready to add to the infusion solution.

Each vial is of single use and should be used immediately.

Allow the required number of boxes of Docetaxel concentrate for solution for infusion to stand below 25?C for 5 minutes before use.

More than one vial of Docetaxel concentrate for solution for infusion may be necessary to obtain the required dose for the patient. Aseptically withdraw the required amount of Docetaxel concentrate for solution for infusion using a calibrated syringe.

In Docetaxel 20 mg /ml vial the concentration of docetaxel is 20 mg/ml.

The required volume of Docetaxel concentrate for solution for infusion must be injected into a 250 ml infusion bag or bottle containing either glucose solution 50 mg/ml (5%) or sodium chloride 9 mg/ml (0.9%) solution for infusion.

If a dose greater than 190 mg of docetaxel is required, use a larger volume of the infusion vehicle so that a concentration of 0.74 mg/ml docetaxel is not exceeded.

Mix the infusion bag or bottle manually using a rocking motion.

The infusion bag solution should be used within 8 hours below 25?C including the one hour infusion to the patient.

As with all parenteral products, Docetaxel infusion solution should be visually inspected prior to use, solutions containing a precipitate should be discarded.

Any unused product or waste material should be disposed of in accordance with local requirements.

7. Manufactured in India By:
TAJ PHARMACEUTICALS LIMITED

at Survey No.188/1 to 189/1,190/1 to 4,
Athiyawad, Dabhel, Daman- 396210 (India)

Docetaxel 20mg/0.5ml Concentrate for solution for infusion (Apidryl) Taj Pharma

Package leaflet: Information for the patient

Docetaxel

Read all of this leaflet carefully before you start using this medicine because it contains important information for you.

  • Keep this leaflet. You may need to read it again.
  • If you have any further questions, ask your doctor, hospital pharmacist or nurse.
  • If you get any side effects talk to your doctor, hospital pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet:

  1. What Docetaxel (Apidryl) is and what it is used for
  2. What you need to know before you use Docetaxel (Apidryl)
  3. How to use Docetaxel (Apidryl)
  4. Possible side effects
  5. How to store Docetaxel (Apidryl)
  6. Contents of the pack and other information

1. What Docetaxel (Apidryl) is and what it is used for

The name of this medicine is Docetaxel (Apidryl). Its common name is docetaxel. Docetaxel is a substance derived from the needles of yew trees.

Docetaxel belongs to the group of anti-cancer medicines called taxoids.

Docetaxel (Apidryl) has been prescribed by your doctor for the treatment of breast cancer, special forms of lung cancer (non-small cell lung cancer), prostate cancer, gastric cancer or head and neck cancer:

  • For the treatment of advanced breast cancer, docetaxel could be administered either alone or in combination with doxorubicin, or trastuzumab, or capecitabine.
  • For the treatment of early breast cancer with or without lymph node involvement, docetaxel could be administered in combination with doxorubicin and cyclophosphamide.
  • For the treatment of lung cancer, docetaxel could be administered either alone or in combination with cisplatin.
  • For the treatment of prostate cancer, docetaxel is administered in combination with prednisone or prednisolone.
  • For the treatment of metastatic gastric cancer, docetaxel is administered in combination with cisplatin and 5-fluorouracil.
  • For the treatment of head and neck cancer, docetaxel is administered in combination with cisplatin and 5-fluorouracil.

2. What you need to know before you use Docetaxel (Apidryl) You must not be given Docetaxel (Apidryl)

  • if you are allergic (hypersensitive) to docetaxel or any of the other ingredients of Docetaxel (Apidryl) (listed in section 6).
  • if the number of white blood cells is too low.
  • if you have a severe liver disease.

Warnings and precautions

Before each treatment with Docetaxel (Apidryl), you will have blood tests to check that you have enough blood cells and sufficient liver function to receive Docetaxel (Apidryl). In case of white blood cells disturbances, you may experience associated fever or infections.

Tell your doctor, hospital pharmacist, or nurse immediately if you have abdominal pain or tenderness, diarrhoea, rectal haemorrhage, blood in stool or fever. These symptoms may be the first signs of a serious gastrointestinal toxicity, which could be fatal. Your doctor should address them immediately.

Tell your doctor, hospital pharmacist or nurse if you have vision problems. In case of vision problems, in particular blurred vision, you should immediately have your eyes and vision examined.

Tell your doctor, hospital pharmacist or nurse if you have experienced an allergic reaction to previous paclitaxel therapy.

Tell your doctor, hospital pharmacist or nurse if you have heart problems.

If you develop acute or worsening problems with your lungs (fever, shortness of breath or cough), please tell your doctor, hospital pharmacist or nurse immediately. Your doctor may stop your treatment immediately.

You will be asked to take premedication consisting of an oral corticosteroid such as dexamethasone, one day prior to Docetaxel (Apidryl) administration and to continue for one or two days after it in order to minimise certain undesirable effects which may occur after the infusion of Docetaxel (Apidryl) in particular allergic reactions and fluid retention (swelling of the hands, feet, legs or weight gain).

During treatment, you may be given other medicines to maintain the number of your blood cells.

Docetaxel (Apidryl) contains alcohol. Discuss with your doctor if you suffer from alcohol dependency, epilepsy or liver impairment. See also section ?Docetaxel (Apidryl) contains ethanol (alcohol)? below.

Other medicines and Docetaxel (Apidryl)

Please tell your doctor or hospital pharmacist if you are taking or have recently taken any other medicine, including medicines obtained without a prescription. This is because Docetaxel (Apidryl) or the other medicine may not work as well as expected and you may be more likely to get a side effect.

The amount of alcohol in this medicinal product may alter the effects of other medicines.

Pregnancy, breast-feeding and fertility

Ask your doctor for advice before being given any medicine.

Docetaxel (Apidryl) must?NOT?be administered if you are pregnant unless clearly indicated by your doctor.

You must not become pregnant during treatment with this medicine and must use an effective method of contraception during therapy, because docetaxel may be harmful for the unborn baby. If pregnancy occurs during your treatment, you must immediately inform your doctor.

You must not breast-feed while you are treated with docetaxel.

If you are a man being treated with Docetaxel (Apidryl) you are advised not to father a child during and up to 6 months after treatment and to seek advice on conservation of sperm prior to treatment because docetaxel may alter male fertility.

Driving and using machines

The amount of alcohol in this medicinal product may impair your ability to drive or use machines. You may experience side effects of this medicine that may impair your ability to drive, use tools or operate machines (see section 4 Possible side effects). If this happens, do not drive or use any tools or machines before discussing with your doctor, nurse or hospital pharmacist.

Docetaxel (Apidryl) contains ethanol (alcohol)

Docetaxel (Apidryl) 20mg/0.5ml contains

50 vol % ethanol anhydrous (alcohol), i.e. up to 395 mg ethanol anhydrous per vial, equivalent to 10 ml of beer or 4 ml wine.

Docetaxel (Apidryl) 80mg/2ml contains

50 vol % ethanol anhydrous (alcohol), i.e. up to 1.58 g ethanol anhydrous per vial, equivalent to 40 ml of beer or 17 ml wine.

Docetaxel (Apidryl) 120mg/3ml contains

50 vol % ethanol anhydrous (alcohol), i.e. up to 3.16 g ethanol anhydrous per vial, equivalent to 80 ml of beer or 33 ml wine.

Harmful for those suffering from alcoholism.

To be taken into account in pregnant or breast-feeding, in children and high-risk groups such as patients with liver disease, or epilepsy.

The amount of alcohol in this medicine may have effects on the central nervous system (the part of the nervous system that includes the brain and spinal cord).

Harmful for those suffering from alcoholism.

To be taken into account in pregnant or breast-feeding, in children and high-risk groups such as patients with liver disease, or epilepsy.

The amount of alcohol in this medicine may have effects on the central nervous system (the part of the nervous system that includes the brain and spinal cord).

3. How to use Docetaxel (Apidryl)

Docetaxel (Apidryl) will be administered to you by a healthcare professional.

Recommended dose
The dose will depend on your weight and your general condition. Your doctor will calculate your body surface area in square meters (m?) and will determine the dose you should receive.

Method and route of administration
Docetaxel (Apidryl) will be given by infusion into one of your veins (intravenous use). The infusion will last approximately one hour during which you will be in the hospital.

Frequency of administration
You should usually receive your infusion once every 3 weeks.

Your doctor may change the dose and frequency of dosing depending on your blood tests, your general condition and your response to Docetaxel (Apidryl). In particular, please inform your doctor in case of diarrhoea, sores in the mouth, feeling of numbness or pins and needles, fever and give any results of your blood tests to your doctor. Such information will allow your doctor to decide whether a dose reduction is needed. If you have any further questions on the use of this medicine, ask your doctor, or hospital pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Your doctor will discuss these with you and will explain the potential risks and benefits of your treatment.

The most commonly reported adverse reactions of docetaxel alone are: decrease in the number of red blood cells or white blood cells, alopecia, nausea, vomiting, sores in the mouth, diarrhoea and tiredness.

The severity of adverse events of docetaxel may be increased when docetaxel is given in combination with other chemotherapeutic agents.

During the infusion at the hospital the following allergic reactions may occur (may affect more than 1 in 10 people):

  • flushing, skin reactions, itching
  • chest tightness; difficulty in breathing
  • fever or chills
  • back pain
  • low blood pressure.

More severe reactions may occur.

If you had an allergic reaction to paclitaxel, you may also experience an allergic reaction to docetaxel, which may be more severe.

The hospital staff will monitor your condition closely during treatment. Tell them immediately if you notice any of these effects.

Between infusions of docetaxel the following may occur, and the frequency may vary with the combinations of medicines that are received

Very common?(may affect more than 1 in 10 people):

  • infections, decrease in the number of red (anaemia), or white blood cells (which are important in fighting infection) and platelets
  • fever: if this happens you must tell your doctor immediately
  • allergic reactions as described above
  • loss of appetite (anorexia)
  • insomnia
  • feeling of numbness or pins and needles or pain in the joints or muscles
  • headache
  • alteration in sense of taste
  • inflammation of the eye or increased tearing of the eyes
  • swelling caused by faulty lymphatic drainage
  • shortness of breath
  • nasal drainage; inflammation of the throat and nose; cough
  • bleeding from the nose
  • sores in the mouth
  • stomach upsets including nausea, vomiting and diarrhoea, constipation
  • abdominal pain
  • indigestion
  • hair loss: in most cases normal hair growth should return. In some cases (frequency not known) permanent hair loss has been observed
  • redness and swelling of the palms of your hands or soles of your feet which may cause your skin to peel (this may also occur on the arms, face, or body)
  • change in the colour of your nails, which may detach muscle aches and pains; back pain or bone pain
  • change or absence of menstrual period
  • swelling of the hands, feet, legs
  • tiredness; or flu-like symptoms
  • weight gain or loss

Common?(may affect up to 1 in 10 people):

  • oral candidiasis
  • dehydration
  • dizziness
  • hearing impaired
  • decrease in blood pressure; irregular or rapid heart beat
  • heart failure
  • oesophagitis
  • dry mouth
  • difficulty or painful swallowing
  • haemorrhage
  • raised liver enzymes (hence the need for regular blood tests)

Uncommon?(may affect up to 1 in 100 people):

  • fainting
  • at the injection site, skin reactions, phlebitis (inflammation of the vein) or swelling
  • blood clots.
  • acute myeloid leukemia and myelodysplastic syndrome (types of blood cancer) may occur in patients who are treated with docetaxel together with certain other anticancer treatments.

Rare?(may affect up to 1 in 1,000 people):

  • inflammation of the colon, small intestine, which could be fatal (frequency not known); intestinal perforation.

Frequency not known (cannot be estimated from the available data):

  • interstitial lung disease (inflammation of the lungs causing coughing and difficulty breathing. Inflammation of the lungs can also develop when docetaxel therapy is used with radiotherapy)
  • pneumonia (infection of the lungs)
  • pulmonary fibrosis (scarring and thickening in the lungs with shortness of breath).
  • blurred vision due to swelling of the retina within the eye (cystoid macular oedema)
  • decrease of the sodium, potassium, magnesium, and/or calcium in your blood (electrolyte balance disorders).
  • ventricular arrhythmia or ventricular tachycardia (manifested as irregular and/or rapid heartbeat, severe shortness of breath, dizziness, and/or fainting). Some of these symptoms can be serious. If this happens, you must tell your doctor immediately
  • injection site reactions at the site of a previous reaction.
  • non-Hodgkin lymphoma (a cancer affecting the immune system) and other cancers may occur in patients who are treated with docetaxel together with certain other anticancer treatments.

Reporting of side effects

If you get any side effects talk to your doctor, hospital pharmacist or nurse. This includes any possible side effects not listed in this leaflet.

5. How to store Docetaxel (Apidryl)

Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the outer carton and on the label of the vial after EXP. The expiry date refers to the last day of that month.
Do not store above 25?C. Store in the original package in order to protect from light.
Use the vial immediately after its opening. If not used immediately, in-use storage times and conditions are the responsibility of the user.
From a microbiological point of view, dilution must take place in controlled and aseptic conditions.
Use the medicine immediately after it is added into the infusion bag. If not used immediately, in-use storage times and conditions are the responsibility of the user and would normally not be longer than 6 hours below 25?C including the one hour infusion.
Physical and chemical in-use stability of the infusion solution prepared as recommended has been demonstrated in non-PVC bags up to 48 hours when stored between 2?C to 8?C.
Prepare the infusion solution as recommended. Do not couple the infusion solution to the infusion set for more than 6 hours when stored at 25?C.
Docetaxel infusion solution is supersaturated, therefore may crystallise over time. If crystals appear, the solution must no longer be used and shall be discarded.
Do not throw away any medicines via wastewater. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. Contents of the pack and other information What Docetaxel (Apidryl) contain
The active substance is docetaxel.

(a) One vial of 0.5ml of concentrate contains 20mg of docetaxel.
Each ml of concentrate contains 40mg docetaxel anhydrous.

(b) One vial of 4ml of concentrate contains 80mg of docetaxel.
Each ml of concentrate contains 40mg docetaxel anhydrous.

(c) One vial of 3ml of concentrate contains 120mg of docetaxel.
Each ml of concentrate contains 40mg docetaxel anhydrous.

The other ingredients are polysorbate 80, ethanol anhydrous (see section 2) and citric acid anhydrous.

What Docetaxel (Apidryl) looks like and contents of the pack

Docetaxel (Apidryl) concentrate for solution for infusion is a clear pale yellow to brownish-yellow solution.
Docetaxel (Apidryl) 20mg/0.5 ml is supplied in a 5 ml clear glass vial with fluorotec plus rubber stopper and aluminium seal and an orange flip-off cap.
Docetaxel (Apidryl) 80mg/2 ml is supplied in a 5 ml clear glass vial with fluorotec plus rubber stopper and aluminium seal and a red flip-off cap.
Docetaxel (Apidryl) 120mg/3 ml is supplied in a 10 ml clear glass vial with fluorotec plus rubber stopper and aluminium seal and a red flip-off cap.
Pack size:
Each box contains one vial of 1ml concentrate.
Each box contains one vial of 4ml concentrate. Each box contains one vial of 8 ml concentrate.

7. Manufactured in India By:
TAJ PHARMACEUTICALS LIMITED

at Survey No.188/1 to 189/1,190/1 to 4,
Athiyawad, Dabhel, Daman- 396210 (India)

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