Cabazitaxel (Jevtana®)
Pronounce: ka-BAZ-i-TAX-el
Classification: Taxane
About Cabazitaxel (Jevtana®)
Cabazitaxel kills cancer cells by changing how the mictrotubules of cancer cells work. By targeting these microtubules, the cancer cells have a hard time growing and dividing.
How to Take Cabazitaxel
This medication is given by intravenous (IV) infusion. The dose is based on your height and weight. Prior to each dose, you will be given medications, including an antihistamine (such as diphenhydramine), a corticosteroid (such as dexamethasone), and an H2 blocker (such as famotidine) to decrease the risk of an infusion reaction.
This medication can cause severe neutropenia (low white blood cell count). Your labs will be monitored weekly during the first cycle and then before the start of more cycles. If you are more at risk of becoming neutropenic (especially those over the age of 65), you may be given a medication that helps stimulate (rev up) the growth of new blood cells.
The blood levels of this medication can be affected by certain medications, so they should be avoided. These include: ketoconazole, itraconazole, posaconazole, voriconazole, clarithromycin, certain antiretroviral drugs used for HIV treatment, carbamazepine, phenytoin, phenobarbital, rifampin, and St. John’s wort. Be sure to tell your provider about all medications and supplements you take.
Possible Side Effects
These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.
Low White Blood Cell Count (Leukopenia or Neutropenia)
White blood cells (WBC) help your body fight infection. While you are having treatment for cancer, your WBC count can drop, putting you at a higher risk of an infection. Tell your provider right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips for preventing infection:
- Hand washing: both yours and your visitors is the best way to prevent the spread of infection.
- Avoid large crowds and people who are sick (those who have a cold, fever, or cough, or live with someone with these symptoms).
- When working outside, wear clothes that protect you, like long pants and gloves.
- Do not handle pet waste.
- Keep all cuts and scratches clean.
- Shower or bathe daily.
- Brush your teeth at least twice a day.
- Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
- Ask your providers before scheduling dental appointments or procedures.
- Ask your providers before you or someone you live with has any vaccines.
Allergic Reactions
Some people may have an allergic reaction to this medication. Signs of an allergic reaction are:
- Shortness of breath or trouble breathing.
- Chest pain.
- Rash.
- Itching.
- Flushing (reddening of the skin, often on the face, neck, or chest).
- A drop in blood pressure (you may feel lightheaded, dizzy, or weak).
If you have any of these signs while you are getting an infusion, tell your provider right away. The infusion will be slowed down or stopped. Depending on your reaction, you may still be able to get the medication if you are given medicine to prevent a reaction or if the medication is given at a slower rate.
Low Red Blood Cell Count (Anemia)
Anemia is when your red blood cell count is lower than normal. Red blood cells carry oxygen to the tissues in your body. When your red cell count is low, you may feel tired or weak. Tell your providers if you have shortness of breath, trouble breathing, or pain in your chest. If your count gets too low, you may receive a blood transfusion.
Low Platelet Count (Thrombocytopenia)
Platelets are blood cells that help your blood clot. Thrombocytopenia is when your platelet count is lower than normal, and you are at a higher risk of bleeding. Tell your providers if you have any bruising or bleeding, including nose bleeds, bleeding gums, or blood in your urine or stool. If your count gets too low, you may receive platelets from a donor.
- Do not use a razor (an electric razor is fine).
- Do not do activities that can cause injury or bleeding.
- Talk to your provider before taking any non-steroidal, anti-inflammatory medications (NSAIDs) like Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), and others. These can raise the risk of bleeding.
- Use a soft-bristle toothbrush to brush your teeth. Ask your provider about flossing or using toothpicks.
Diarrhea with Dehydration
Diarrhea can be a serious side effect that can lead to dehydration (when you do not have enough fluid in your body). Tell your healthcare provider if you have diarrhea.
Diarrhea is when you pass three or more stools in a day. Your providers can suggest medications to relieve diarrhea. Do not take any medications to manage your diarrhea without talking to your provider first because your stool may need to be tested. To manage it, try eating foods that are low in fiber and bland, like white rice and boiled or baked chicken. Try not to eat raw fruits, vegetables, whole grain breads, cereals, and seeds. Soluble fiber is a type of fiber found in some foods that helps absorb (soak up) fluid. Foods high in soluble fiber are applesauce, bananas (ripe), canned fruit, oranges, boiled potatoes, white rice, foods made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Stay hydrated by drinking 8 to 10 glasses of non-alcoholic, non-caffeinated fluid each day.
Nausea and/or Vomiting
Talk to your providers if you have nausea and/or vomiting. They can prescribe medications to help you. Making changes to your diet can also help. Avoid things that make your symptoms worse, like heavy or greasy/fatty foods and spicy or acidic foods, like tomatoes, lemons, and oranges. Try saltines or ginger ale to help your symptoms.
Call your providers if you cannot keep fluids down for more than 12 hours or if you feel lightheaded or dizzy.
Fatigue
Fatigue can cause exhaustion, feeling worn out and that your body is "heavy" and hard to move, or being unable to focus. It is common when you have cancer, and it is not the same as feeling tired. You may need to adjust your schedule to manage fatigue. Plan times to rest during the day and save your energy for more important activities. Exercise can help lessen fatigue. Talk to your providers about ways to deal with this side effect.
Constipation
Constipation is when you have less bowel movements than usual or are having trouble passing stool. To relieve constipation, you can include fiber in your diet (fruits like prunes, apples, peaches, and pear nectars/juices), drink 8 to 10 glasses of non-alcoholic fluids a day, and stay active. Taking a stool softener once or twice a day can prevent constipation. If you do not have a bowel movement for 2 to 3 days, call your provider.
This medication can cause a blockage in the bowel, so constipation should be taken seriously.
Fertility
This medication may affect your fertility. It can cause changes to your menstrual cycle or sperm. You may want to consider sperm banking or egg harvesting if you might wish to have a child in the future. Talk about your options with your provider before treatment.
Reproductive Concerns
There is a higher risk of health problems for your baby if you are pregnant, become pregnant, or get someone pregnant while on this medication. To lower the risk of birth defects, you should use birth control (contraception) to avoid pregnancy. Talk with your provider about what kind of birth control is safest for you and your partner.
If you can get someone pregnant, you will need to use effective birth control during treatment and for 4 months after the last dose of this medication, even if you believe you are not producing sperm.
Important but Less Common Side Effects
Gastrointestinal (GI) Bleed & Tear
This medication can cause bleeding or a tear in the wall of your gastrointestinal (GI) system. Signs of these problems are:
- Bright red blood in your stool or black stools.
- Coughing up blood.
- Vomiting blood or vomit that looks like coffee grounds.
- Fever.
- Severe pain in your abdomen (belly) or new abdominal swelling.
If you have any of these symptoms, call 911.
Kidney Problems
This medication can cause kidney failure. Your kidney function will be monitored throughout treatment. If you experience swelling of your face or body, a decrease in the amount of urine you are producing, or if your urine appears darker in color or if there is blood in it, call your provider immediately.
Lung Problems
This medication can cause respiratory disorders such as pneumonia, pneumonitis (inflammation), interstitial lung disease, and acute respiratory distress syndrome. If you develop any issues with breathing such as becoming short of breath, contact your provider immediately.