3 The technology

3.1 Docetaxel (Sanofi-Aventis) is an anti-neoplastic drug that belongs to a class of drugs known as taxanes. It works by disrupting the microtubular network that is essential for mitotic and interphase cellular functions, causing inhibition of cell division and cell death.

3.2 Docetaxel is licensed for use in combination with prednisone or prednisolone for the treatment of patients with hormone-refractory metastatic prostate cancer.

3.3 Docetaxel is administered as a 1-hour infusion once every 3 weeks. The recommended dose is 75 mg/m2, with twice daily oral administration of prednisone or prednisolone at a dose of 5 mg.

3.4 Reported adverse effects of docetaxel include hypersensitivity reactions (presenting as flushing, skin reactions, hypotension and bronchospasm), bone marrow suppression (neutropenia, thrombocytopenia, anaemia), cutaneous reactions, fluid retention, peripheral neuropathy, alopecia, cardiac disorders and tiredness. Contraindications include severe allergic reaction, low white blood cell count due to bone-marrow damage (myelosuppression), or severe liver disease. Premedication with a corticosteroid is usually recommended to help prevent allergic reaction. For full details of side effects and contraindications, see the summary of product characteristics.

3.5 The net price of docetaxel (40 mg/ml) is £162.75 for a 0.5 ml vial and £534.75 for a 2 ml vial (excluding VAT; 'British national formulary', 50th edition). The cost per patient, assuming an average of seven cycles of treatment, would be approximately £8000. Costs may vary in different settings because of negotiated procurement discounts.