Last update March 24, 2019

Docetaxel

Very High Risk

Very unsafe. Contraindicated. Use of an alternative or cessation of breastfeeding. Read the Comment.

Docetaxel is a semisynthetic taxane with antimitotic properties similar to paclitaxel. Indicated for the treatment of various cancers (breast, lung, prostate, gastric, head, neck).
Intravenous administration; a dose generally every 3 weeks during a number of cycles determined according to protocol. Some studies indicate weekly dosage (Hainsworth 2004).

Since the last update we have not found published data on its excretion in breastmilk.

As it is highly lipophilic, it is likely that, like paclitaxel, it is excreted in significant quantities in breastmilk (Zagouri 2013).

It is known from pharmacokinetics that after 3 elimination half-lives (T½) 87.5% of the drug is eliminated from the body; after 4 T½ it is 94%, after 5 T½, 96.9%, after 6 T½, 98.4% and after 7 T½ it is 99%. From 7 T½ the plasma concentrations of the drug in the body are negligible. In general, a period of at least five half-lives can be considered a safe waiting period before breastfeeding again (Anderson 2016).

Taking the longest T½ published as a reference, these 5 T½ would correspond to 2.5 days. As it is a highly lipophilic drug, with a structure very similar to paclitaxel, which is known to be excreted in breastmilk, and with significant adverse effects, it would be advisable to wait for 7 T½, which would correspond to 3.5 days. Meanwhile, express and discard milk from the breast regularly.

Expert authors recommend waiting 4 to 5 days (between 8 and 10 T½) after the last dose to resume breastfeeding (Hale 2017).

When it is possible to do so, detections in the breastmilk of each patient to determine the total elimination of the drug would be the best indicator of resuming breastfeeding between two cycles of chemotherapy.

Some chemotherapeutic agents with antibiotic effects can alter the composition of the microbiota (bacterial cluster or bacterial flora) of the milk and the concentration of some of its components (Urbaniak 2014). This possibly occurs temporarily with subsequent recovery, although no harmful effects are expected nor have been reported in breastfed infants.

Women undergoing chemotherapy during pregnancy have lower rates of breastfeeding due to experiencing difficulties with breastfeeding (Stopenski 2017), needing more support to achieve it.

Given the strong evidence that exists regarding the benefits of breastfeeding for the development of babies and the health of mothers, it is advisable to evaluate the risk-benefit of any maternal treatment, including chemotherapy, individually advising each mother who wishes to continue with breastfeeding (Koren 2013)

Alternatives

We do not have alternatives for Docetaxel.

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Docetaxel in other languages or writings:

Group

Docetaxel belongs to this group or family:

Tradenames

Main tradenames from several countries containing Docetaxel in its composition:

Pharmacokinetics

Variable Value Unit
Molecular weight 808 daltons
Protein Binding 95 %
VD 1.6 l/Kg
pKa 10.96 -
11 hours

References

  1. AEMPS-Aurovitas. Docetaxel. Ficha técnica. 2018 Full text (in our servers)
  2. Stopenski S, Aslam A, Zhang X, Cardonick E. After Chemotherapy Treatment for Maternal Cancer During Pregnancy, Is Breastfeeding Possible? Breastfeed Med. 2017 Mar;12:91-97. Abstract
  3. Anderson PO. Cancer Chemotherapy. Breastfeed Med. 2016 May;11:164-5. Abstract Full text (link to original source) Full text (in our servers)
  4. Urbaniak C, McMillan A, Angelini M, Gloor GB, Sumarah M, Burton JP, Reid G. Effect of chemotherapy on the microbiota and metabolome of human milk, a case report. Microbiome. 2014 Jul 11;2:24. Abstract Full text (link to original source) Full text (in our servers)
  5. Koren G, Carey N, Gagnon R, Maxwell C, Nulman I, Senikas V; Society of Obstetricians and Gynaecologists of Canada. Cancer chemotherapy and pregnancy. J Obstet Gynaecol Can. 2013 Mar;35(3):263-278. Abstract Full text (link to original source) Full text (in our servers)
  6. Zagouri F, Psaltopoulou T, Dimitrakakis C, Bartsch R, Dimopoulos MA. Challenges in managing breast cancer during pregnancy. J Thorac Dis. 2013 Abstract Full text (link to original source) Full text (in our servers)
  7. Pistilli B, Bellettini G, Giovannetti E, Codacci-Pisanelli G, Azim HA Jr, Benedetti G, Sarno MA, Peccatori FA. Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: how should we counsel cancer patients about breastfeeding? Cancer Treat Rev. 2013 May;39(3):207-11. Abstract
  8. FDA-Sandoz. Docetaxel. Drug Summary. 2012 Full text (in our servers)
  9. Hainsworth JD. Practical aspects of weekly docetaxel administration schedules. Oncologist. 2004 Abstract

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