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LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-.

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LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet].

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Last Update: September 7, 2020.


The taxanes or taxoids are a closely related group of antineoplastic agents that have a unique mechanism of action as inhibitors of mitosis and which are widely used in the therapy of ovarian, breast, lung, esophageal, prostate, bladder and head and neck cancers. Three taxanes are in clinical use, paclitaxel (Taxol: 1992), docetaxel (Taxotere: 1996) and cabazitaxel (Jevtana: 2010). Paclitaxel was the first compound in this chemical group to be introduced into clinical use and was initially isolated from the bark of the Western yew tree. Docetaxel is a semisynthetic analogue of paclitaxel and a derivative of extracts from needles of the European Yew (Taxus baccata) that has somewhat better pharmacokinetics and different side effects than paclitaxel. Cabazitaxel is also a semisynthetic analogue of natural taxoids and was developed for its lack of affinity for P-glycoprotein, a common mediator of docetaxel resistance. The taxanes are similar to the vinca alkaloids in that they bind to tubulin and cause inhibition of mitosis. However, the taxanes bind at a different site than the vinca alkaloids and cause inhibition of mitosis by prevention of degradation of microtubules, rather than prevention of their assembly. The three taxanes are all given intravenously, usually every 1 to 3 weeks. Taxanes have many side effects and can be associated with serum enzyme elevations during treatment, and rarely with clinically apparent liver injury. The few case reports of acute liver injury associated with taxanes (largely docetaxel but also paclitaxel) have occurred in patients with acute hypersensitivity infusion reactions. The hepatic injury varies in severity but can be severe and lead to acute liver failure and death.

Drug Class: Antineoplastic Agents

Drugs in the Subclass, Taxanes: Cabazitaxel, Docetaxel, Paclitaxel


References updated: 07 September 2020

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    (Textbook of hepatotoxicity published in 1999; paclitaxel and docetaxel are not mentioned).
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    (Review of hepatotoxicity of cancer chemotherapeutic agents; the taxanes are not specifically discussed).
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    (Among 655 patients treated with paclitaxel, dose limiting toxicities included bone marrow suppression [especially neutropenia], mucositis, neuropathy and rarely cardiomyopathy; hypersensitivity reactions can be controlled with premedication; liver test abnormalities were dose dependent with any AST elevations in 7-26% of patients and values >5 times ULN in only 2% of those receiving the highest dose).
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    (Extensive review of toxicities of paclitaxel; according to data on file with the sponsor, elevations of AST, Alk P and bilirubin >5 times the ULN occurred in <1% of 402 patients in phase II and III trials).
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    (Overall response rates to docetaxel and paclitaxel in advanced breast cancer ranged from 29-68% of patients; major dose related toxicities included neutropenia, mucositis, cardiomyopathy and fluid retention; hepatotoxicity was not mentioned).
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    (67 year old man with prostate cancer developed Stevens-Johnson Syndrome, neutropenia and thrombocytopenia after 5 weekly infusions of docetaxel, with subsequent rise in liver tests and jaundice that progressed to hepatic failure and death; few details provided).
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    (Among 755 men with castration-resistant prostate cancer after failure of docetaxel who were treated with iv cabazitaxel or mitoxantrone every 3 weeks with daily oral prednisone, overall survival was greater with cabazitaxel [15.1 vs 12.7 months], but side effects required careful monitoring including neutropenia [94%], anemia [93%], thrombocytopenia [47%], diarrhea [47%], and adverse event related deaths [4.8% vs 1.1% with mitoxantrone] which were considered possibly related to therapy in 2.6% vs 0.3%).
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  • Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, Reddy KR, et al. United States Drug Induced Liver Injury Network. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN Prospective Study. Gastroenterology. 2015;148:1340–52.e7. [PMC free article: PMC4446235] [PubMed: 25754159]
    (Among 899 cases of drug induced liver injury enrolled in a US prospective study between 2004 and 2013, 49 [5.5%] were attributed to antineoplastic agents of which only 1 was due to a taxane [docetaxel]).


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