1. Aschenbrenner, Diane S. MS, APRN-BC


* Cabazitaxel (Jevtana) has been approved to treat hormone-refractory prostate cancer.


* The drug is administered concurrently with prednisone.


* Severe, life-threatening neutropenia and hypersensitivity reactions can occur.



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In hormone-refractory prostate cancer, the cancer cells continue to grow even after drugs to suppress testosterone are given. The drug cabazitaxel (Jevtana), a microtubule inhibitor that disrupts mitotic and interphase cellular functions, has now been approved to treat hormone-refractory prostate cancer that has worsened during or after treatment with docetaxel (Taxotere), the drug typically used to treat this disease. Cabazitaxel is to be administered as an IV infusion every three weeks concurrently with oral prednisone. In the one clinical trial performed to date, which involved 755 patients, cabazitaxel was found to lengthen survival by a few months in patients who received cabazitaxel and prednisone, in comparison with another chemotherapy drug, mitoxantrone (which was also administered with prednisone).


Cabazitaxel carries a black box warning regarding two serious risks, that deaths from neutropenia have occurred during drug therapy and that severe hypersensitivity reactions (with generalized rash or erythema, hypotension, and bronchospasm) can occur; patients with a history of severe hypersensitivity reactions to this drug or to other drugs formulated with polysorbate shouldn't receive cabazitaxel.


The most common adverse effects (occurring in 10% or more of patients) are neutropenia, anemia, leukopenia, thrombocytopenia, diarrhea (which can be severe enough to cause fatal dehydration), fatigue, nausea, vomiting, constipation, asthenia, abdominal pain, hematuria, back pain, anorexia, peripheral neuropathy, fever, the loss of or an altered sense of taste, cough, arthralgia, and alopecia. Fatal effects of the drug (not related to disease progression) are more likely to be seen in older adults, who are also more prone to neutropenia and febrile neutropenia.


Special precautions must be taken in order to administer the drug safely: two dilutions are required before administration, as is a premedication regimen to minimize the risk of severe hypersensitivity reactions. Nurses should carefully read the package insert prior to preparing and administering cabazitaxel. Nurses should also monitor patients' blood counts carefully while they're receiving cabazitaxel. Emergency equipment should be nearby during administration. Patients who develop diarrhea need to be carefully assessed for signs of dehydration and treated appropriately.