Docetaxel and nintedanib

Docetaxel with nintedanib is a cancer drugs combination. You pronounce these drug names as:

• docetaxel (doe-see-tax-el)
• nintedanib (nin-ted-a-nib)

Docetaxel is also called Taxotere. And nintedanib is also known as Vargatef.

It is a treatment for people with a type of non-small cell lung cancer (NSCLC) called adenocarcinoma who have already had one type of chemotherapy and whose lung cancer has:

• spread to surrounding tissues (locally advanced)
• spread to distant parts of the body (metastatic cancer)
• come back near the original (primary) cancer after treatment 

How do docetaxel and nintedanib work?

Docetaxel is a chemotherapy drug. It works by destroying quickly dividing cancer cells. And nintedanib is a type of targeted cancer drug called a cancer growth blocker.

The body produces natural substances called growth factors that encourage cells including cancer cells to grow. Nintedanib is a type of cancer growth blocker called a tyrosine kinase inhibitor. It stops chemical messages being sent to a number of growth factors including:

• vascular endothelial growth factor (VEGF) – this controls blood vessel development
• platelet derived endothelial growth factor (PDGF) – controls blood vessel development and cell growth
• fibroblast growth factor (FGF) – controls cell growth

Blocking these messages stops the cancer cell from growing and dividing.

How do you have docetaxel with nintedanib?

You have docetaxel as a drip into your bloodstream (intravenously). And you take nintedanib as a capsule that you swallow whole with a glass of water.  You should take nintedanib with food.

Into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

Risk of tissue damage

When you are having this treatment through a cannula it could damage the tissue if it leaks out of the vein. This is called extravasation. This can happen anywhere along the vein that the drug is going into. It doesn’t happen very often. Tell your nurse straight away if you notice any changes such as swelling, redness, pain, burning, or a stinging feeling.

Your nurse will stop the drug treatment. And they will treat the area to relieve symptoms and reduce tissue damage. Contact your healthcare team if you develop any of these symptoms when you are at home.

Taking your capsules

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug, or if you have missed a dose.

How often do you have docetaxel with nintedanib?

You have docetaxel and nintedanib as cycles of treatment. This means you have the drugs and then a rest to allow your body to recover. You usually take nintedanib twice a day, morning and evening, 12 hours apart. 

Each cycle lasts 3 weeks (21 days). You usually have 4 to 6 cycles of docetaxel and nintedanib.

You have it in the following way:

You then start your next cycle.

When you have finished taking docetaxel and nintedanib together, you carry on taking nintedanib on its own every day.

You usually keep taking nintedanib for as long as it is working or until the side effects get too bad.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Before treatment starts you may have a blood test to check for viruses such as hepatitis B, hepatitis C, and HIV . This is called a viral screen.

It’s important for your doctor to know if you have had any of these viruses. This is because this treatment can weaken your immune system and can cause the virus to become active again (reactivation). 

What are the side effects of docetaxel with nintedanib?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, cough, headaches, feeling cold and shivery, pain or a burning feeling when peeing, or generally feeling unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Liver changes

You might have liver changes that are usually mild that are picked up on blood tests. Less commonly nintedanib can cause your liver to not work as well as it should and you may have a build up of the substance bilirubin . Nintedanib can also cause other serious liver problems but this is rare.

Tell your nurse or doctor if you have any of the following symptoms: itchy skin, yellowing of the skin and whites of the eyes, dark pee or tummy pain. 

You have regular blood tests to check for any changes in the way your liver is working.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Loss of appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Numbness or tingling in fingers or toes

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your healthcare team if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Change in the levels of minerals in the blood 

You may have changes to the levels of minerals and salts in your blood. These minerals and salts include potassium and sodium. If you have a low potassium level, symptoms can include changes in your heart rhythm, muscle cramps, tiredness and feeling sick.

Your healthcare team will do regular blood tests to check for any changes during your treatment. 

Skin rash

Skin problems include a skin rash, dry skin and itching. Your healthcare team can tell you what products you can use on your skin to help.

Sore mouth

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Inflammation of the digestive system

You might get inflammation of the lining of your digestive system. This  can cause symptoms such as pain, weakness, feeling sick, bloating, diarrhoea, high temperature, loss of appetite and blood in your poo.

Speak to your doctor or nurse if you have these symptoms.

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Bleeding

There is a risk of bleeding, the most common type is a nosebleed. You might also have bleeding in other parts of your body, for example, your lungs, tummy (abdomen) or brain.

Contact your healthcare team straight away if you cough up blood, notice blood in your sick or poo or if you get bleeding from your back passage (rectum). 

You may bruise more easily, but this is less common. Let your doctor or nurse know if this happens.

 Hair loss

You may have some hair loss or hair thinning. This can be upsetting. Your hair might grow back once treatment has finished.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• sepsis - a serious reaction to an infection. Signs can include feeling very unwell, not passing urine, a very high or very low temperature, shivering, slurred speech or confusion, breathlessness, mottled or discoloured skin, extreme shivering or muscle pain. Call 999 or go to accident and emergency (A&E) immediately if you have any of these symptoms
• blood clots that can be life threatening; signs are pain, redness, and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
• high blood pressure - symptoms can include blurred vision, nosebleeds, dizziness, headaches, shortness of breath and chest pain
• lack of fluid in the body (dehydration) - signs include feeling dizzy, not passing enough pee and dark coloured pee
• a collection of pus (abscess) - these can be painful and can develop anywhere in the body
• protein in your urine - you may notice you have to pee more often or have swelling in your feet and around your face. Let your nurse or doctor know if this happens
• weight loss
• headaches – tell your healthcare team if you keep getting headaches

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• a hole in your stomach or bowel (perforation) - contact your doctor straight away if you have pain, severe cramps, feeling tightness or bloating in the stomach area
• heart attack - call 999 or go to A&E if you think you are having a heart attack
• inflammation of your pancreas (pancreatitis) - symptoms include severe tummy pain, feeling or being sick, a high temperature or you may have loose poo
• your kidneys may stop working – symptoms might include not passing enough pee, breathlessness, feeling tired and weak, confused, feeling sick, and you might have swelling on your legs, ankles and feet

Other side effects

There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:

• weakness in a blood vessel wall causing it to bulge (aneurysm) which sometimes can rupture (burst) or a tear in one of the main arteries - these are both an emergency. Symptoms depend on which blood vessel is affected. But they normally include sudden severe pain, sweating and shortness of breath. You should call 999 if you get these symptoms
• inflammation of the bowel (colitis) symptoms can include diarrhoea, passing blood when you have a poo, urgency to have a poo, and tummy pain
• posterior reversible encephalopathy syndrome (PRES). This is a rare disease of the nerves that causes headache, seizures, confusion and changes in vision. Contact your health team straight away if you get these symptoms
• slow wound healing. If you need to have an operation you may need to stop taking nintedanib for a while beforehand. Your doctor will let you know when you can start taking it again

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Do not take nintedanib if you are allergic to peanuts or soya. The capsule contains soya products. People who have a peanut allergy can also have an allergic reaction to soya preparations. This allergic reaction could be life threatening. Talk to your doctor if you have a peanut allergy and don’t know if you are allergic to soya.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment and for at least 6 months after finishing docetaxel. If you are still taking nintedanib, you should not become pregnant or get someone pregnant for at least 3 months after you finish nintedanib.

Talk to your doctor, nurse, or pharmacist about effective contraception before starting treatment. This treatment may have an effect on how well oral hormonal contraceptives work. If you’re taking the oral contraceptive pill you should also use barrier contraceptives such as condoms.

Let your doctor or nurse know straight away if you or your partner falls pregnant while having treatment.

Breastfeeding

Don’t breastfeed during this treatment. This is because the drugs may come through in your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having.

Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, and yellow fever.

You can usually have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine

Talk to your doctor or pharmacist about the best time to have a vaccine in relation to your cancer treatment.

Contact with others who have had immunisations 

You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your immune system is weakened.

Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine.

More information

For further information about each drug and the possible side effects go to the electronic Medicines Compendium (eMC) website. You can find patient information leaflets for each drug on this website.

You can report any side effect you have to the Medicines and Healthcare Regulatory Agency (MHRA) as part of their Yellow Card Scheme.