Severe colitis associated with docetaxel use: A report of four cases

Table 1 Comparison of four patients with taxane-associated colitis

	Case 1	Case 2	Case 3	Case 4
Age (yr), Sex	83, male	47, male	41, female	55, female
Diagnosis	Adenocarcinoma of the pancreas	Adenocarcinoma of the lung	Invasive ductal carcinoma of the breast	Invasive ductal carcinoma of the breast
Chemotherapy (all were 21-d cycles)	Docetaxel 30 mg/m2 Day 1 & 8 Capecitabine 1600 mg/m2 days 1-14	Docetaxel 70 mg/m2 day 1 Carboplatin AUC 6 day 1	Docetaxel 70 mg/m2 day 1 Cisplatin 70 mg/m2 day 1	Docetaxel 70 mg/m2 day 1 Cyclophosphamide 600 mg/m2 day 1
Clinical presentation	Severe bloody diarrhea and dehydration on cycle 1 day 8	Severe bloody diarrhea, febrile neutropenia and diffuse abdominal pain on cycle 3 day 10	Severe diarrhea positive for occult blood, abdominal pain, and leukocytosis on cycle 2 day 9	Severe abdominal pain with guarding on cycle 1 day 9
Antibiotic exposure	No	No	No	No
C. difficile toxin	Negative (3 samples)	Positive (2 of 3 samples)	Negative (3 samples)	Not performed
Endoscopic findings	Pseudomembranes in the rectum, sigmoid and descending colon	Pseudomembranes in the sigmoid and descending colon	Moderate to severe mucosal inflammation of the sigmoid and the rectum with diffuse subepithelial hemorrhages	Endoscopy not performed. Laparotomy revealed sigmoid perforation with peritonitis
Treatment	Oral vancomycin	IV metronidazole and oral vancomycin	Oral metronidazole	Surgical resection of affected colonic segment
Outcome	Symptoms resolved	Symptoms resolved	Symptoms resolved	Developed postoperative intra-abdominal abscess which was drained and subsequently recovered fully