Last update March 24, 2019
Very High Risk
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)
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.
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e-lactancia is a resource recommended by Asociación Española de Bancos de Leche Humana of Spain
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