Taxane Chemotherapy (Second-Line) Pregnancy: Contraindicated in pregnancy — cytotoxic

Cabazitaxel

Brand names: Jevtana

Adult dose

Dose: 25 mg/m2 IV every 3 weeks (with prednisone 10 mg/day oral)

Route: Intravenous infusion (over 1 hour)

Frequency: Every 3 weeks

Max: 25 mg/m2 per cycle

Premedicate with antihistamine (dexchlorpheniramine or equivalent), corticosteroid, and H2 antagonist. G-CSF mandatory. Approved for mCRPC after docetaxel failure

Paediatric dose

Dose: Not applicable N/A/kg

Route: IV

Frequency: Not applicable

Max: Not applicable

Not applicable in paediatrics

Dose adjustments

Renal

No adjustment for mild-moderate impairment; caution in severe impairment

Hepatic

Contraindicated in bilirubin above ULN or ALT/AST above 1.5x ULN

Paediatric weight-based calculator

Patient weight (kg)

Not applicable in paediatrics

Clinical pearls

TROPIC trial: cabazitaxel demonstrated survival benefit over mitoxantrone in docetaxel-refractory mCRPC — established its role as standard second-line chemotherapy
G-CSF primary prophylaxis is mandatory with cabazitaxel — not optional; febrile neutropenia rate without G-CSF is unacceptably high
Diarrhoea can be severe and life-threatening — aggressive management with loperamide; dose reduction required for grade 3 or above diarrhoea
CARD trial: cabazitaxel superior to abiraterone or enzalutamide as third-line therapy in men who progressed on prior novel androgen receptor pathway inhibitor
Primary oncology team must manage this agent — complex toxicity profile requires specialist monitoring

Contraindications

Severe hepatic impairment
Neutrophil count under 1.5 x 10^9/L
Hypersensitivity to cabazitaxel or polysorbate 80

Side effects

Neutropenia (severe — G-CSF mandatory)
Diarrhoea (common, can be severe)
Anaemia
Fatigue
Peripheral neuropathy
Haematuria
Renal failure

Interactions

Strong CYP3A4 inhibitors (increase cabazitaxel exposure — avoid)
Strong CYP3A4 inducers (rifampicin — reduce efficacy)

Monitoring

FBC (weekly for first cycle, then before each cycle)
LFTs
Renal function
Diarrhoea severity
Peripheral neuropathy

Reference: BNFc; BNF 90; NICE TA391 (Cabazitaxel for mCRPC); TROPIC Trial; CARD Trial; EAU Guidelines 2024. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways