Chemotherapy drugs are powerful and can take a toll on the body. Reactions to drugs can vary widely from patient to patient, so it’s important to pay attention to any side effects that you experience, expected or otherwise.

The chemotherapy drug docetaxel is very well tolerated, and many men are surprised to find that disease-related symptoms (pain, fatigue, loss of energy) are improved after starting this therapy. However, docetaxel does have some side effects to be aware of. For example, between 5% and 10% of men will experience a fever with a low white blood cell count that will require medical attention and can be life threatening. The risk can be reduced through the use of white blood cell growth factors (Neulasta®); note that the use of this supportive medication is at the discretion of the physician who must weigh the benefits of Neulasta against its side effects. Despite use of Neulasta, there is still a risk of serious infection. About 50% of men will experience significant fatigue at some point in their therapy, usually for the first week of each cycle. About one-third of men will experience numbness or weakness in their toes or fingers that may interfere with function (neuropathy). This side effect is not always reversible, but in most cases resolves slowly over time. There are no treatments available to prevent neuropathy, but reducing the dose of docetaxel, delaying the next dose, or stopping treatment can slow neuropathy and potentially prevent it from progressing. It is important to talk with your doctor if you are developing neuropathy so that you can speak together about how to best handle further cycles of docetaxel.

Other side effects of docetaxel include low platelets which can result in bleeding (1%), anemia (5%), reduced heart function (10%), hair loss (65%), diarrhea (32%), nail changes (30%), loss of appetite (20%), shortness of breath (15%), and fluid retention (10% to 20%). Most of these are mild, reversible, and treatable, and should not be a reason to avoid chemotherapy if you need it.

Cabazitaxel, which affects blood counts, is almost always given with Neulasta to boost infection-fighting white blood cells because life-threatening infection due to a depressed immune system is the most serious side effect associated with this medication. A blood transfusion is sometimes necessary to treat anemia to combat the fatigue and shortness of breath related to low blood counts. Other possible side effects include: fatigue (37%), neuropathy (13%), shortness of breath (12%), headache (8%), hair loss (10%), abdominal pain (17%), diarrhea (6%), and low blood pressure
(5%). Fortunately, recent data suggests that the side effects of cabazitaxel may be reduced, and the drug equally effective, if it is given at a lower dose than was initially approved. Talk with your doctor about whether the reduced dose of cabazitaxel from the recently reported FIRSTANA trial may be a better option for you than the initially reported and FDA-approved dose.

Regardless of the type of chemotherapy you are receiving, you will be monitored very closely by doctors, nurses, and pharmacists to make sure that all side effects are being addressed. Many of these side effects, especially fever and inability to keep food/drink down, need to be addressed right away—don’t wait until your next appointment to tell your provider.