Docetaxel + Abiraterone + Leuprolide Regimen

 Dosing

– Docetaxel: 75 mg/m² IV over 1 hour every 3 weeks

– Abiraterone: 1000 mg orally once daily

– Prednisone: 5 mg orally twice daily (given with abiraterone)

– Leuprolide (Lupron Depot): 22.5 mg IM every 3 months

 Administration

– Docetaxel: Administered on day 1 of each 21-day cycle

– Abiraterone and Prednisone: Administered continuously

– Leuprolide: Administered as an intramuscular injection every 3 months

Premedication for Docetaxel

– Dexamethasone: 8 mg orally twice daily for 3 days, starting 1 day before docetaxel infusion

 Toxicity Profiles

 Docetaxel

– Neutropenia (very common)

– Anemia

– Fatigue

– Nausea/vomiting

– Diarrhea

– Fluid retention

– Peripheral neuropathy

– Nail changes

– Alopecia

 Abiraterone

– Fatigue

– Joint swelling/discomfort

– Edema

– Hot flashes

– Diarrhea

– Elevated liver enzymes

– Hypokalemia

– Hypertension

– Urinary tract infection

Leuprolide

– Hot flashes

– Decreased libido

– Erectile dysfunction

– Bone pain

– Injection site reactions

– Gynecomastia

– Fatigue

– Increased risk of cardiovascular events

– Osteoporosis

 Monitoring

– Complete blood counts prior to each docetaxel cycle

– Liver function tests monthly

– Electrolytes, including potassium

– Blood pressure

– Testosterone levels to ensure castration levels are maintained

 Dose Adjustments

– Docetaxel: Reduce dose for hematologic toxicities

– Abiraterone: Hold for Grade 3-4 hepatotoxicity until recovery

– Leuprolide: No specific dose adjustments, but monitor for cardiovascular and bone health

This regimen combines the cytotoxic effects of docetaxel with the androgen synthesis inhibition of abiraterone and the testosterone suppression of leuprolide. Close monitoring is required, especially for hematologic, hepatic, and cardiovascular toxicities. The steroid premedication helps reduce docetaxel-related adverse effects.