Cabazitaxel (Jevtana ®)
Cabazitaxel (Jevtana ®) is a chemotherapy drug used to treat advanced prostate cancer when the cancer can no longer be controlled by hormonal therapy. Cabazitaxel is given to people after they've been treated with the chemotherapy drug docetaxel.
This information should ideally be read with our general information about chemotherapy and your type of cancer.
The National Institute for Health and Care Excellence (NICE) gives advice on which new drugs or treatments should be available on the NHS in England and Wales. The Scottish Medicines Consortium (SMC) is an organisation similar to NICE for the NHS in Scotland. Although cabazitaxel is licensed and can be prescribed in the UK, it has not currently been approved for use by NICE or the SMC. As a result, cabazitaxel may not be widely available on the NHS. In England, cabazitaxel is available at some hospitals via the Cancer Drugs Fund. In Northern Ireland, you can find out if this drug is available on the NHS from your hospital team.
We have more information on what you can do if a treatment isn’t available.
How cabazitaxel is given
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You usually have cabazitaxel in the chemotherapy day unit or during a short stay in hospital. A chemotherapy nurse will give it to you. During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse in the outpatient clinic. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse will give you some medicines as an injection about 30 minutes before the chemotherapy. These are to reduce the risk of an allergic reaction and other side effects. You will also have some anti-sickness drugs as an injection or as tablets. The nurse will give you these drugs and the chemotherapy through one of the following:
a short thin tube (cannula) that the nurse puts into a vein in your arm or hand
a fine tube that goes under the skin of your chest and into a vein close by (central line)
a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Your nurse gives you cabazitaxel as a drip (infusion) into your cannula or line over about one hour. They usually run the drip through a pump, which gives you the treatment over a set time.
When the chemotherapy is being given
Some people might have side effects while they are having the chemotherapy:
Rarely, cabazitaxel may cause an allergic reaction while it’s being given. Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of a reaction can include: a rash; feeling itchy, flushed or short of breath; swelling of your face or lips; feeling dizzy; having pain in your tummy, back or chest; or feeling unwell. Tell your nurse straight away if you have any of these symptoms.
You’re more likely to have an allergic reaction during your first or second cycle of cabazitaxel. Your nurse will give you drugs to help reduce the risk of a reaction.
The drug leaks outside the vein
If this happens when you’re having cabazitaxel, it can damage the tissue around the vein. This is called extravasation. Tell the nurse straight away if you have any stinging, pain, redness or swelling around the vein. Extravasation is not common, but if it happens it’s important that it’s dealt with quickly.
If you get any of these symptoms after you get home, contact the doctor or nurse straightaway on the number they gave you.
Your course of chemotherapy
You will have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. Each cycle of cabazitaxel usually takes 21 days (three weeks). You have the drug on the first day of each cycle. Your doctor or nurse will tell you more about this and the number of cycles you are likely to have.
Before you go home, the nurse or pharmacist will give you anti-sickness drugs to take. You will also have prednisolone (a steroid) to take every day. Take all your tablets exactly as they have been explained to you.
Possible side effects of cabazitaxel
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We explain the most common side effects of cabazitaxel here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. If you are having other chemotherapy drugs as well, you may have some side effects that we don’t list here. Always tell your doctor or nurse about the side effects you have.
Your doctor can prescribe drugs to help control some side effects. It is very important to take them exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you. Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
Risk of infection
Cabazitaxel can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia. Your white blood cells start to reduce seven days after treatment and are usually at their lowest 10–14 days after.
Contact the hospital straight away on the contact number you’ve been given if:
your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
you suddenly feel unwell, even with a normal temperature
you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough or needing to pass urine often.
The number of white blood cells usually increases steadily and returns to normal before your next chemotherapy. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.
Your nurse may give you injections of a drug called GCSF under the skin. It encourages the bone marrow (where blood cells are made) to make more white blood cells.
Bruising and bleeding
Cabazitaxel can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets .
Anaemia (low number of red blood cells)
Cabazitaxel can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
This can sometimes be severe. Your doctor can prescribe anti-diarrhoea drugs to control it. You may be given these before you leave hospital. It’s important to take them exactly as your nurse or pharmacist explained. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
If you have diarrhoea more than 4–6 times a day or at night, contact the hospital straight away on the numbers your nurse gave you. Your treatment may need to be delayed. When the diarrhoea improves, the doctors will tell you if you can start it again. Sometimes they reduce the dose.
This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.
Loss of appetite
You may lose their appetite during your treatment. Try to eat small meals regularly. Don’t worry if you don’t eat much for a day or two. If your appetite doesn’t improve after a few days, let your nurse or dietitian know. They can give you advice on getting more calories and protein in your diet. They may give you food supplements or meal replacement drinks to try. Your doctor can prescribe some of these and you can buy them from chemists.
Cabazitaxel may make you constipated and cause tummy pain. Drinking at least two litres of fluids (three and a half pints) every day will help. Try to eat more foods that contain fibre (such as fruit, vegetables and wholemeal bread) and take some regular gentle exercise.
If you haven’t had a bowel motion for two days, contact the hospital for advice. Your doctor can prescribe laxatives to help you. Always contact the hospital straight away if you are constipated and have tummy pain or are being sick.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s over. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Muscle or joint pain/weakness
You may get pain in your joints or muscles for a few days after chemotherapy or you may feel very weak. Tell your doctor if this happens so they can prescribe painkillers. Let them know if the pain does not get better. Try to get plenty of rest. Taking regular warm baths may help.
Numb or tingling hands or feet
These symptoms are caused by the effect of cabazitaxel on the nerves. It’s called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks.
Always tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes, but in some people, they may never go away. Talk to your doctor if you are worried about this.
Cough or shortness of breath
Cabazitaxel can cause changes to the lungs. Always tell your doctor if you develop wheezing, a cough, a fever or feel breathless. You should also let them know if any existing breathing problems get worse. If necessary, they can arrange for you to have tests to check your lungs.
Blood in the urine
It’s common for people with advanced prostate cancer to have blood in their urine. This may increase when you are given cabazitaxel. Contact your doctor if you notice increased blood in your urine after being treated with cabazitaxel.
Changes in the way the kidneys work
Cabazitaxel can affect how your kidneys work. You will have blood tests to check how well your kidneys are working. Your nurse will ask you to drink plenty of fluid.
It is important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don't mention here.
Other information about cabazitaxel
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Blood clot risk
Cancer increases the chances of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Cabazitaxel can affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor before treatment starts.
Your doctor will advise you not to become pregnant or father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluid.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This section has been compiled using information from a number of reliable sources, including:
electronic Medicines Compendium (eMC). medicines.org.uk (accessed August 2013).
British National Formulary. 65th edition. 2013. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Micromedex® 2.0. Truven Health Analytics Inc. micromedexsolutions.com (accessed August 2013).
With thanks to: Penny Daynes Haematology/Oncology Pharmacist, who reviewed this edition.
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