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Coming to end of chemo, wondering what's next

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User

Posted 26 May 2025 at 10:34

Hi Harry

I have been reading the NICE guidline from 2006 on docetaxel treatment for hormone refractory metastatic prostate cancer. The standard dose of 75mg/m2 comes from a pivotal randomised controlled clinical trial (TAX327) where 335 patients were treated with 3 week cycles of docetaxel at 75mg/m2 up to a maximum of 10 cycles. This treatment was compared with two other treatments.

As a result of this trial and some others as well as input from clinical experts NICE decided in 2006 to approve 3 week cycles of docetaxel with a maximum of 10 treatments.

NICE reviewed docetaxel treatment in 2019 with the latest bevidence from new studies including STAMPEDE.They were happy with the 75mg/m2 dose. I'm not sure if any other dose has been tried in a clinical trial.

So, this still leaves the question. At what dose does docetaxel cease to be effective?

Cheers

Tom

User

Posted 28 May 2025 at 22:36

Hi Tom,

I read that 60 mg/m2 is the lowest they reduce it to so I’m now on the lowest dose. If that dose still can’t be tolerated by some people, they stop the treatment.

I also found details of a study carried out about 20 years ago. In view of the toxicity of the taxane-based chemotherapy they investigated biweekly low doses of Docetaxel (30 mg/m2) in patients with HRPC. The conclusion was that this could be considered an effective nontoxic therapeutic option to be confirmed in larger scale trials. There were also trials back then for weekly treatment cycles of low dose (25 mg/m2) Docetaxel for patients with HRPC previously exposed to chemotherapy, which they reckoned were effective and well-tolerated.

I haven’t been able to establish what the eventual conclusions were, or whether these regimens were eventually approved.

Had my last cycle today. They were running 2½ hrs late so didn’t get started until 5.30. Have started getting blackened nails recently and actually lost two toenails the other day. It’s a common side effect of Docetaxel and I understand they grow back eventually. They just told me to keep an eye on them in case of possible infection and make sure nails are kept short so they don’t catch on clothing.

Making the most of my food in anticipation of altered taste in a few days’ time.

Cheers, Harry

User

Posted 29 May 2025 at 12:38

Hi Harry

You've obviously been doing your research as well. Although I said I was not aware of lower does there must have been Phase II dose finding/efficacy studies before they landed on 75mg/m2. I was told by my oncologist that the dose coukd be reduced by a maximum of 20% which puts it close to your 60mg/m2.

I had my 4th yesterday with what I was told would be a 10% reduction. So far today I feel as fine as I have been on the treatment.

I can vouch that lost toe nails do grow back. I have lost big toe nails through all the running I did over 40 years through the impact on the toe box of my running shoes.

My fingers are crossed for you that all is downhill from now on.

Cheers

Tom

User

Posted 03 Jun 2025 at 19:07

Hi Tom,

I hope the 10% reduction has helped with the breathlessness and that you’ll be able to continue with further cycles for as long as the consultant thinks necessary.

I didn’t get the metallic taste this time – just hardly any taste at all. My wife has been spicing up our meals with chilli and sprinkles of cayenne pepper, which I can taste, but can’t take too much of the stuff.

I had another phone review today and my PSA is down a bit further to 6.4. The next steps are the CT and bone scans then a face-to-face with results in 3 weeks. It will be interesting to see what they propose for the next step.

Fingers crossed for you too.

Cheers, Harry

User

Posted 15 Jun 2025 at 16:26

Hi Harry

I'm still pretty breathless even after very mild exertion. I suppose in some ways I've been lucky as I don't have any other major side effects at least so far. I've just had a chest CT scan to see if there is anything to explain the breathlessness but don't have the results yet.

It looks like you're moving in the right direction

Keep me posted on your progress.

Cheers

Tom

User

Posted 16 Jun 2025 at 20:00

Hi Tom,

Shame the reduction in dosage hasn't made any difference to your breathlessness. At least they’re checking it out to make sure there isn’t another cause apart from another chemo side effect. I expect they also checked for anaemia. These chemo teams don’t hang about whenever a new symptom is reported.

The Macmillan site has a booklet you can download on breathlessness and ways to manage it which you may find helpful, although I should imagine much of it is down to common sense. https://www.macmillan.org.uk/cancer-information-and-support/stories-and-media/booklets/managing-breathlessness

Just had my CT scan and the bone scan is tomorrow. The nerves are starting to kick in a bit for next week’s final review.

Hope you soon get the results of your CT scan and it’s clear.

Cheers, Harry

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