ACTIVITY AND TOXICITY OF DOCETAXEL (TAXOTERE(R)) IN WOMEN WITH PREVIOUSLY TREATED METASTATIC BREAST-CANCER

Background: Metastatic breast cancer is a major cause of cancer death in Australian women. Docetaxel is a new cytotoxic drug that has shown promise in the treatment of metastatic breast cancer in patients who h ave previously received other chemotherapy, particularly an anthracycl ine, and has recently been approved for marketing in Australia. Aim: T o report the first Australian experience with docetaxel in a group of women with metastatic breast cancer. Methods: Patients with progressiv e metastatic breast cancer who had previously received other chemother apy were treated with docetaxel 75 mg/m(2) or 100 mg/m(2) given as a o ne hour infusion every three weeks. All patients received oral dexamet hasone for five days starting 24 hours prior to docetaxel as prophylax is against fluid retention. The patients' response to docetaxel and to xicity were assessed by standard criteria. Results: Twenty-six patient s were treated. The major toxicity was neutropenia with 92% of patient s experiencing at least one episode of grade 4 (absolute neutrophil co unt <0.5x10(9)/L) neutropenia. Hospital admission for febrile neutrope nia occurred in 44% of patients with one death from sepsis. Cumulative fluid retention was observed but in only one patient was it dose-limi ting. Apart from alopecia, other toxicities were infrequent and rarely serious. In 23 patients assessable for response, there were 11 partia l responses (48%). Three other patients whose disease could not be ass essed for response had clinical improvement. The median survival of al l patients treated was eight months. Conclusions: The response rate ob served with docetaxel is comparable to that seen in trials in the Unit ed States and Europe and confirms the high activity of this new cytoto xic agent. Neutropenia is the major toxicity, and consideration should be given to the use of prophylactic oral antibiotics or colony stimul ating factors to try and prevent febrile episodes. Clinicians will nee d to balance the benefits, toxicities, and cost of docetaxel in determ ining the appropriateness of its use in their patients.