Cabazitaxel

INTRODUCTION

Indications

Hormone-refractory metastatic prostate cancer previously treated with a regimen including docetaxel (used in combination with prednisone).

Action

Binds to intracellular tubulin and promotes its assembly into microtubules while inhibiting disassembly. Result is inhibition of mitosis and interphase. Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones, with ↓ spread of metastatic prostate cancer.

Adverse Reactions/Side Effects

CNS: weakness, fatigue. Resp: dyspnea. CV: arrhythmias, hypotension. GI: DIARRHEA, abdominal pain, abnormal taste, anorexia, constipation, nausea, vomiting, dyspepsia. GU: RENAL FAILURE, hematuria. Derm: alopecia. F and E: electrolyte imbalance. Hemat: NEUTROPENIA, THROMBOCYTOPENIA, anemia, leukopenia. MS: arthralgia, back pain, muscle spasms; Neuro: peripheral neuropathy; Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Watch for signs of renal failure, including decreased urine output, hematuria, increased blood pressure, muscle cramps/twitching, edema/weight gain from fluid retention, yellowish brown skin, and confusion that progresses to seizures and coma. Report these signs to the physician or nursing staff immediately.

• Watch for signs of leukopenia and neutropenia (fever, sore throat, other signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia. Report these signs to the physician or nursing staff immediately.

• Watch for untoward GI reactions, and immediately report severe or prolonged diarrhea.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

• Monitor signs of electrolyte imbalances, including high plasma potassium levels (bradycardia, fatigue, weakness, numbness, tingling), high calcium levels (muscle pain and weakness, joint pain, confusion, lethargy), or high phosphate levels (ectopic calcification). Notify physician because severe cases can lead to life-threatening arrhythmias and paralysis.

• Be alert for signs of peripheral neuropathy, such as numbness, tingling, and decreased muscle strength. Establish baseline electroneuromyo-graphic values using EMG and nerve conduction at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

• Assess any joint pain, back pain, or muscle spasms to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

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