This information is about a chemotherapy treatment for breast cancer called capecitabine and docetaxel. It describes the drugs used, how they are given and some of the possible side effects. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

The treatment involves the two chemotherapy drugs: capecitabine and docetaxel, which is commonly called Taxotere®.

Capecitabine is available as 500mg peach coloured tablets and 150mg light-peach coloured tablets. Taxotere is a colourless fluid.

Your chemotherapy treatment is usually given to you as a day patient. You will need to have a blood test before you start treatment - either on the same day, or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.

The nurse will then put a thin tube (cannula) into a vein in your arm or hand. You may find this uncomfortable or a little painful but it should not take long. Some people have their chemotherapy given through a thin plastic tube that is inserted under the skin into a vein near the collarbone (central line) or through a vein in their arm (PICC line).

You will be given some anti-sickness (anti-emetic) drugs. These are usually given by injection through the cannula, which is connected to a drip, but some anti-sickness drugs can also be taken as tablets.

The drugs are then given separately, starting with:

• A drip (infusion) of taxotere that lasts for about an hour.
• You will then be given capecitabine tablets to take home. Capecitabine is usually given as a combination of 500mg and 150mg tablets. You need to make sure that you are taking the right dose. The tablets should be swallowed whole with a glass of water, within half an hour of the end of a meal. You should take them in the morning after breakfast, and again in the evening, after your evening meal, so that doses are spaced at least eight hours apart.

If you are having your treatment as a day patient, you can then go home. The cannula will be removed and you will be given a supply of anti-sickness tablets to take with you. It is important to take these as directed, even if you are not feeling sick - as some anti-sickness drugs are much better at preventing sickness than stopping it once it has started.

You doctor may use the word 'regimen' (eg capecitabine/docetaxel regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular chemotherapy treatment that you are receiving.

On the first day of treatment you will start your capecitabine tablets, which you will take twice daily for two weeks. On the same day you will also be given a drip (infusion) of Taxotere. When you finish your capecitabine tablets you will have a rest period with no chemotherapy for the next week. This completes what is called a cycle of your chemotherapy.

You will start the next cycle of your treatment after the rest period, which will be three weeks after your first injection. This treatment is usually given for 4–6 cycles over a period of 3–4 months. This makes up a course of treatment.

Each person's reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described below will not affect everyone who is having capecitabine/docetaxel chemotherapy. We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you do notice any effects which you think may be due to the drug but which are not listed here, please let your nurse or doctor know.

Diarrhoea This can be quite severe but can usually be controlled with medicines. If you have diarrhoea more than 4–6 times a day, contact your specialist immediately. You may be advised to stop taking capecitabine. It is often possible, however, to restart the treatment at a lower dose. It is important to drink plenty of fluids if you have diarrhoea.

Lowered resistance to infection The chemotherapy can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, with your resistance to infection usually reaching its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.

Bruising or bleeding The chemotherapy can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with capecitabine/docetaxel you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if this is a problem.

Sore mouth and ulcers Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can give you special mouthwashes and medicines to prevent or clear any mouth infection.

Taste changes You may also notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Allergic reaction Signs of an allergic reaction include rashes and itching, a high temperature, shivering, redness of the face, a feeling of dizziness, headache, breathlessness, anxiety and a need to pass urine. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these symptoms. A course of steroid tablets will be prescribed to reduce the chance of developing an allergic reaction and to help reduce other side effects, such as fluid retention (see below). This course may start shortly before you are due to be given your treatment. It is important to take the steroid tablets as prescribed.

Soreness and redness or darkening of the palms of the hands and soles of the feet This is sometimes known as palmar plantar syndrome or hand foot syndrome. You may be prescribed vitamin B6 (pyridoxine), which can help to reduce this. A rash, and dry or itchy skin, may also occur. If you notice this, let your doctor or nurse know.

Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. If the sickness is not controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness drugs that may be more effective. Some anti-sickness medicines cause drowsiness. If you feel drowsy or unwell, do not operate machinery or drive. Other anti-sickness drugs may cause constipation. Let your doctor or nurse know if this is a problem.

Hair loss This usually starts 2–3 weeks after the first course of treatment (and is due to the docetaxel). Hair is usually lost completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will start to grow again once the treatment has finished.

Scalp cooling is a method of reducing hair loss that may be helpful for some people. You can ask your doctor or nurse if it is available at your hospital.

Tiredness Many people feel extremely tired (fatigued) during chemotherapy. This is a very common side effect and it is important to try to get as much rest as you need.

Abdominal pain and constipation It may help to drink plenty of fluids, eat a high-fibre diet and take gentle exercise. Sometimes you may need to take medicines to stimulate your bowel. These can be prescribed by your doctor or bought from a pharmacy.

Loss of appetite A dietitian or specialist nurse at your hospital can give advice on boosting your appetite, coping with eating difficulties and maintaining weight.

Fluid retention You may notice that you gain weight and/or that your ankles and legs swell. This decreases slowly once your treatment has finished. To help reduce the chance of fluid retention you will be given steroid tablets (usually dexamethasone) to take for three days beginning the day before treatment.

Headaches and dizziness Tell your doctor if you have headaches or feel dizzy and lightheaded while taking capecitabine.

Increased production of tears This may be caused by capecitabine and is temporary.

Numbness or tingling of the hands or feet This is due to the effect of docetaxel on the nerves and is known as peripheral neuropathy. You may also notice that you have difficulty with doing up buttons or other fiddly tasks. Tell your doctor if you notice any numbness or tingling of your hands or feet. This usually improves slowly a few months after the treatment.

Pain in joints or muscles This may be caused by docetaxel. It is important to tell your doctor about this, so that appropriate painkillers can be prescribed.

Changes in nails The colour of your nails may change. This change grows out over several months once the treatment has finished. Pain in the nail bed (at the base of the nail) may occur, but this is rare.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs to thin the blood. Your doctor or nurse can give you more information. 

Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Interaction with other drugs Capecitabine may affect the action of some medication given to thin the blood (anti-coagulants), such as warfarin. Let your doctors know if you take warfarin, as they will need to check more often how quickly your blood is clotting.

Let your doctor know if you are taking folic acid because it might increase the side effects of capecitabine.

Leakage into the tissue around the vein If you notice any stinging or burning around the vein while the drug is being given, or any leakage of fluid from the cannula site, it is very important that you tell the doctor or nurse immediately. If the area around the injection site becomes red or swollen at any time, let your doctor or nurse know.

Fertility Your ability to become pregnant or father a child may be affected by this treatment. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while having capecitabine and docetaxel as these drugs may harm the developing foetus. It is important to use effective contraception whilst having the treatment and for at least a few months afterwards. Again, discuss this with your doctor.

• It is important to take your tablets at the right times. You must take them as directed by your doctor, specialist nurse or pharmacist.
• Keep the tablets in the original packaging and store them at room temperature, away from heat and direct sunlight.
• Keep the tablets in a safe place out of the reach of children, as capecitabine could harm them.
• If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
• If you are sick just after taking the tablets let your doctor know as you may need to take another dose. Do not take another tablet without telling your doctor.
• If you forget to take a tablet do not take a double dose. Inform your doctor and keep to your regular dose schedule.

This section is based upon our capecitabine and docetaxel chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott, Williams and Wilkins, 2001.

For further references, please see general bibliography.