BEIZRAY Docetaxel 20 mg/mL Injection, Solution — NDC 70710-2152-1 (Billing 70710-2152-01)
This is a package of BEIZRAY Docetaxel 20 mg/mL Injection, Solution from Zydus Pharmaceuticals USA Inc., marketed since Aug 2025 and currently FDA-listed. It is this product's only package size.
NDC database record
One package, one record: these facts belong to NDC 70710-2152-1 alone.
- Record
- FDA NDC Directory package listing · Human prescription drug
- Code segments
- 70710 labeler · 2152 product · 1 package
- Package marketed since
- Aug 28, 2025
- Sample package
- Yes — professional sample, not for sale
- Listing certified through
- Dec 31, 2026
- Barcode (UPC-A, from the NDC)
- 3 7071021521 7
- FDA record last changed
- Jul 24, 2026
Identity & classification
Regulatory identifiers FDA, NLM and CMS codes for this package
- RxCUI (RxNorm): 1860480
Where does this data come from?
- FDA openFDA NDC Directory · synced Oct 8, 2026
- FDA label on DailyMed · label index refreshed Oct 6, 2026
- RxNorm (NLM RxNav) · catalog refreshed Oct 1, 2026
- Medi-Span GPI (licensed)
- First Databank (licensed) · refreshed Oct 8, 2026
RxNorm drug class
This medicine belongs to the Microtubule Inhibitor class.
Where does this data come from?
- RxClass (NLM) · catalog refreshed Oct 1, 2026
Clinical
Docetaxel injection is used alone or in combination with other medications to treat certain types of breast, lung, prostate, stomach, and head and neck cancers. Docetaxel injection is in a class of medications called taxanes. It works by stopping the growth and spread of cancer cells.
Read the full MedlinePlus article ↗- It is a chemotherapy medicine used for certain breast, lung, prostate, stomach, and head and neck cancers. Which cancer and which combination you get depends on your situation. You...
- It is given through an IV, usually over about an hour every 3 weeks, at a medical facility. You will take steroid medicine by mouth beforehand to help lower the risk of reactions.
- Common ones include tiredness, hair loss, nausea, diarrhea, mouth sores, nail changes, swelling, and numbness or tingling. Low blood counts can also happen. Tell your team about an...
- Call for fever, chills, or signs of infection, trouble breathing, swelling of the face or throat, a severe rash, vision changes, severe diarrhea, or fast weight gain or swelling. T...
Patient education
Supplement & herbal interactions
Some supplements/herbs that may interact with Docetaxel — tap one for details:
Where does this data come from?
- MedlinePlus (NLM) · refreshed Oct 1, 2026
- FDA label on DailyMed · label index refreshed Oct 6, 2026
Ask a licensed pharmacist directly — free, answered by our team.
Pricing
A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.
| Price system | Per mL | Per package |
|---|---|---|
| Retail pharmacies payNADAC · weekly | Not in the retail survey — common for institutional, discontinued, or low-volume packs. | |
| Medicaid paysCMS SDUD · 12 mo | No recent Medicaid claims on file for this NDC — rare and low-volume NDCs are suppressed in the public data. | |
| Medicare drug plans payPart D · quarterly | No Part D plan price is available for this NDC in our data. | |
Where does this data come from?
- CMS NADAC weekly file
- CMS ASP pricing files · refreshed Sep 20, 2026
- CMS Medicaid State Drug Utilization Data · refreshed Oct 8, 2026
- CMS Part D plan pricing files · refreshed Sep 24, 2026
- VA National Acquisition Center price file
Packaging — all sizes for this product
| Package NDC | Description | Marketing start | Marketing end | Status |
|---|---|---|---|---|
| 70710-2152-01 You're viewing this Main listing | 1 VIAL, GLASS in 1 CARTON / 4 mL in 1 VIAL, GLASS Sample | 2025-08-28 | — | Active |
Therapeutic equivalents
| Product | Labeler | Pack | NADAC/unit | TE | Status | Price vs. this |
|---|---|---|---|---|---|---|
| Docetaxel 20 mg/mL 00143-9205-01 | Hikma | 1 vial | — | AP | FDA listed | — |
| Docetaxel 80 mg/4mL 00955-1021-04 | Sanofi-Aventis | 1 vial | — | — | FDA listed | — |
| Docetaxel 80 mg/4mL 23155-0904-31 | Heritage | 1 vial | — | AP | FDA listed | — |
| Docetaxel 20 mg/mL 25021-0245-01 | Sagent | 1 vial | — | AP | FDA listed | — |
| Docetaxel 80 mg/4mL 43598-0259-40 | Dr. | 4 ml | — | AP | FDA listed | — |
| Docetaxel 80 mg/4mL 43598-0610-40 | Dr. | 4 ml | — | AP | FDA listed | — |
| Docetaxel 20 mg/mL 45963-0765-52 | Actavis | 1 vial | — | AP | FDA listed | — |
| Docetaxel 80 mg/4mL 47335-0895-40 | Sun | 1 vial | — | — | FDA listed | — |
| Docetaxel 80 mg/4mL 57884-3042-01 | Jiangsu | 1 vial | — | AP | FDA listed | — |
| Docetaxel 80 mg/4mL 70121-1222-01 | Amneal | 1 vial | — | AP | FDA listed | — |
| Beizray 20 mg/mLthis 70710-2152-01 | Zydus | 1 vial | — | — | FDA listed | — |
| Docetaxel 20 mg/mL 71288-0152-04 | Meitheal | 1 vial | — | — | FDA listed | — |
| Beizray 20 mg/mL 83513-0009-01 | Zhuhai | 4 ml | — | — | FDA listed | — |
| Docetaxel 20 mg/mL 47335-0323-40 | Sun | 1 vial | — | — | FDA listed | — |
| Beizray 20 mg/mL 70710-2092-08 | Zydus | 1 vial | — | — | FDA listed | — |
| Beizray 20 mg/mL 83513-0008-01 | Zhuhai | 1 vial | — | — | FDA listed | — |
| Docetaxel 20 mg/mL 16729-0267-63 | Accord | 1 vial | — | AP | FDA listed | — |
| Docetaxel 20 mg/mL 70121-1221-01 | Amneal | 1 vial | — | AP | FDA listed | — |
Where does this data come from?
- FDA openFDA NDC Directory · synced Oct 8, 2026
- FDA Orange Book · refreshed Oct 3, 2026
- CMS NADAC weekly file
Availability & generic status
The FDA lists approved generic versions of this medicine, but that does not always mean a pharmacy can get one today. Patent rules, launch agreements, supply and pricing can affect when generics actually arrive.
Why the date isn’t exact: Generic timing can change because patents may be challenged, settled, licensed, added, removed, or worked around with a narrower label — and FDA approval does not always mean a pharmacy can get the generic today.
🛈 What do these terms mean?
- Patent
- Legal protection listed in the Orange Book that may delay generic approval or launch. Issued by the U.S. Patent & Trademark Office.
- Substance patent
- Covers the active drug molecule itself — the hardest to design around. A generic generally can’t launch until it expires.
- Formulation (product) patent
- Covers a specific formulation or dosage form. A generic can sometimes work around it with a different formulation.
- Method-of-use patent
- A patent covering one specific approved use of the drug — not necessarily the whole molecule. A generic can sometimes launch with a “skinny label” that carves out the protected use and keeps the others.
- Skinny label
- A generic label that omits a still-patented use when the FDA allows it — letting a generic reach the market for the unprotected uses.
- Exclusivity
- FDA-granted marketing protection, separate from patents — e.g. 5-yr new chemical entity, 7-yr orphan drug, or a +6-month pediatric extension.
- Paragraph IV
- A generic applicant’s formal challenge to a listed patent. It can potentially lead to earlier generic entry, but often involves litigation or a settlement.
- RLD / RS
- Reference Listed Drug — the brand product the FDA uses as the reference for generic applications. Reference Standard — the product the FDA expects generics to compare against in bioequivalence testing.
- TE / AB rating
- FDA therapeutic-equivalence rating. An AB rating generally means the FDA considers a generic therapeutically equivalent to — and substitutable for — the brand.
- LOE (loss of exclusivity)
- The latest patent or exclusivity currently listed — the loss-of-exclusivity / latest-listed-protection date shown on this page. Paragraph-IV challenges and settlements can move the real date earlier; FDA approval and a manufacturer’s decision to market can move it later.
Built from the FDA Orange Book. The bars above are scaled to each protection’s expiry; the red LOE marker is the last one to lapse.
| Patent | Type | Use code | Expires |
|---|---|---|---|
| US 11419842 ↗ | Method of use | U-881 | May 16, 2036 |
| US 11419842 ↗ | Method of use | U-937 | May 16, 2036 |
| US 11419842 ↗ | Method of use | U-946 | May 16, 2036 |
| US 11419842 ↗ | Method of use | U-4027 | May 16, 2036 |
| US 11419842 ↗ | Method of use | U-4028 | May 16, 2036 |
| US 12090134 ↗ | Method of use | U-881 | May 16, 2036 |
| US 12090134 ↗ | Method of use | U-937 | May 16, 2036 |
| US 12090134 ↗ | Method of use | U-946 | May 16, 2036 |
| US 12090134 ↗ | Method of use | U-4027 | May 16, 2036 |
| US 12090134 ↗ | Method of use | U-4028 | May 16, 2036 |
| US 12090135 ↗ | Drug product | — | May 16, 2036 |
Is there a generic version of this drug?
The FDA approved a generic — why can’t I get it at my pharmacy yet?
Why do different websites show different generic release dates?
What does “FDA listed” mean?
What does a patent or protection date mean here?
What does “current Orange Book estimate” mean?
Can a generic come out before the last patent expires?
Can a generic come out after the listed dates?
What is the difference between patents and exclusivity?
Why are there multiple patent dates?
Where does this data come from?
- FDA Orange Book · refreshed Oct 3, 2026
Inactive Ingredients / Excipients
Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.
🧪 Avoiding an ingredient? See Docetaxel inactive ingredients by manufacturer: every current product's list side by side, so you can ask your pharmacy for the version that does not list it.
💡 Tap an ingredient (hover on desktop) to see what it is and why it’s used.
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UNII 3K9958V90M
A liquid solvent derived from fermentation or chemical synthesis. In medicines, alcohol dissolves active ingredients, helps preserve the product, and improves how the body absorbs certain drugs.
-
UNII DSO12WL7AU
A salt derived from citric acid, this ingredient acts as a buffer and pH regulator in medicines. It helps maintain stable acidity levels and may improve taste or aid preservation.
2 inactive ingredients listed in the exact product block matched to this NDC.
Where does this data come from?
ingredient classCode="IACT" elements from the exact product block matched by this NDC. Label-section narrative from DailyMed / the openFDA label index is shown separately when available.- FDA label on DailyMed · label index refreshed Oct 6, 2026
- FDA openFDA NDC Directory · synced Oct 8, 2026
Inactive ingredient FAQ
Are inactive ingredients the same for every manufacturer?
Why might an inactive ingredient be missing?
Can inactive ingredients matter?
Manufacturer & labeler
More NDCs from Zydus Pharmaceuticals USA Inc. labeler code 70710
- BEIZRAY docetaxel Kit NDC 70710-2093-4
- JAYTHARI Oral Suspension Deflazacort 22.75 mg/mL Suspension NDC 70710-2131-3
- Carbidopa and Levodopa 23.75 mg; 95 mg Capsule, Extended Release NDC 70710-2139-1
- Carbidopa and Levodopa 36.25 mg; 145 mg Capsule, Extended Release NDC 70710-2140-1
- Carbidopa and Levodopa 48.75 mg; 195 mg Capsule, Extended Release NDC 70710-2141-1
- Carbidopa and Levodopa 61.25 mg; 245 mg Capsule, Extended Release NDC 70710-2142-1
- Riociguat .5 mg Tablet, Film Coated NDC 70710-2156-8
- Riociguat 1 mg Tablet, Film Coated NDC 70710-2157-8
- Riociguat 1.5 mg Tablet, Film Coated NDC 70710-2158-8
- Riociguat 2 mg Tablet, Film Coated NDC 70710-2159-8
- Riociguat 2.5 mg Tablet, Film Coated NDC 70710-2160-8
- Ascorbic acid 500 mg/mL Injection NDC 70710-2162-8
Where does this data come from?
- FDA openFDA NDC Directory · synced Oct 8, 2026
- Drugs@FDA
Full prescribing information FDA SPL
🚨 Boxed Warning ▾
WARNING: TOXIC DEATHS, HEPATOTOXICITY, NEUTROPENIA, HYPERSENSITIVITY REACTIONS, and FLUID RETENTION Treatment-related mortality associated with BEIZRAY is increased in patients with abnormal liver function, in patients receiving higher doses, and in patients with non- small cell lung carcinoma and a history of prior treatment with platinum-based chemotherapy who receive BEIZRAY as a single agent at a dose of 100 mg/m 2 [see Warnings and Precautions ( 5.1 )] . Avoid the use of BEIZRAY in patients with bilirubin > upper limit of normal (ULN), or to patients with AST and/or ALT >1.5 × ULN concomitant with alkaline phosphatase >2.5 × ULN.
Patients with elevations of bilirubin or abnormalities of transaminase concurrent with alkaline phosphatase are at increased risk for the development of severe neutropenia, febrile neutropenia, infections, severe thrombocytopenia, severe stomatitis, severe skin toxicity, and toxic death. Patients with isolated elevations of transaminase >1.5 × ULN also had a higher rate of febrile neutropenia. Measure bilirubin, AST or ALT, and alkaline phosphatase prior to each cycle of BEIZRAY [see Warnings and Precautions ( 5.2 )] .
Do not administer BEIZRAY to patients with neutrophil counts of <1500 cells/mm 3 . Monitor blood counts frequently as neutropenia may be severe and result in infection. [see Warnings and Precautions ( 5.3 )] . Do not administer BEIZRAY to patients who have a history of severe hypersensitivity reactions to docetaxel [see Contraindications ( 4 )] .
Severe hypersensitivity reactions have been reported in patients despite dexamethasone premedication. Hypersensitivity reactions require immediate discontinuation of the BEIZRAY infusion and administration of appropriate therapy [see Warnings and Precautions ( 5.5 )]. Severe fluid retention occurred in 6.5% (6/92) of patients despite use of dexamethasone premedication.
It was characterized by one or more of the following events: poorly tolerated peripheral edema, generalized edema, pleural effusion requiring urgent drainage, dyspnea at rest, cardiac tamponade, or pronounced abdominal distention (due to ascites) [see Warnings and Precautions ( 5.6 )] . WARNING: TOXIC DEATHS, HEPATOTOXICITY, NEUTROPENIA, HYPERSENSITIVITY REACTIONS, and FLUID RETENTION See full prescribing information for complete boxed warning. Treatment-related mortality increases with abnormal liver function, at higher doses, and in patients with NSCLC and prior platinum-based therapy receiving BEIZRAY at 100 mg/m 2 ( 5.1 ) Avoid use of BEIZRAY if bilirubin > ULN, or if AST and/or ALT >1.5 × ULN concomitant with alkaline phosphatase >2.5 × ULN.
LFT elevations increase risk of severe or life-threatening complications. Obtain LFTs before each treatment cycle ( 5.2 ) Do not administer BEIZRAY to patients with neutrophil counts <1500 cells/mm 3 . Obtain frequent blood counts to monitor for neutropenia ( 4 , 5.3 ) Severe hypersensitivity, including fatal anaphylaxis, has been reported in patients who received dexamethasone premedication.
Severe reactions require immediate discontinuation of BEIZRAY and administration of appropriate therapy ( 5.5 ) Contraindicated if history of severe hypersensitivity reactions to docetaxel ( 4 ) Severe fluid retention may occur despite dexamethasone ( 5.6 )
🎯 Indications and Usage ▾
1 INDICATIONS AND USAGE BEIZRAY is a microtubule inhibitor indicated for: Breast Cancer (BC) : single agent for locally advanced or metastatic BC after chemotherapy failure; and with doxorubicin and cyclophosphamide as adjuvant treatment of operable node-positive BC ( 1.1 ) Non-small Cell Lung Cancer (NSCLC) : single agent for locally advanced or metastatic NSCLC after platinum therapy failure; and with cisplatin for unresectable, locally advanced or metastatic untreated NSCLC ( 1.2 ) Castration-Resistant Prostate Cancer (CRPC) : with prednisone in metastatic castration-resistant prostate cancer ( 1.3 ) Gastric Adenocarcinoma (GC) : with cisplatin and fluorouracil for untreated, advanced GC, including the gastroesophageal junction ( 1.4 ) Squamous Cell Carcinoma of the Head and Neck (SCCHN) : with cisplatin and fluorouracil for induction treatment of locally advanced SCCHN ( 1.5 )
1.1Breast Cancer BEIZRAY is indicated for the treatment of patients with locally advanced or metastatic breast cancer after failure of prior chemotherapy. BEIZRAY in combination with doxorubicin and cyclophosphamide is indicated for the adjuvant treatment of patients with operable node-positive breast cancer.
1.2Non-small Cell Lung Cancer BEIZRAY as a single agent is indicated for the treatment of patients with locally advanced or metastatic non-small cell lung cancer after failure of prior platinum-based chemotherapy. BEIZRAY in combination with cisplatin is indicated for the treatment of patients with unresectable, locally advanced or metastatic non-small cell lung cancer who have not previously received chemotherapy for this condition.
1.3Prostate Cancer BEIZRAY in combination with prednisone is indicated for the treatment of patients with metastatic castration-resistant prostate cancer.
1.4Gastric Adenocarcinoma BEIZRAY in combination with cisplatin and fluorouracil is indicated for the treatment of patients with advanced gastric adenocarcinoma, including adenocarcinoma of the gastroesophageal junction, who have not received prior chemotherapy for advanced disease.
1.5Head and Neck Cancer BEIZRAY in combination with cisplatin and fluorouracil is indicated for the induction treatment of patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN).
⏱️ Dosage and Administration ▾
2 DOSAGE AND ADMINISTRATION Do not substitute BEIZRAY for other docetaxel products. ( 2.1 ) Administer in a facility equipped to manage possible complications (e.g., anaphylaxis). Administer intravenously (IV) over 1 hour every 3 weeks.
BC locally advanced or metastatic: 60 mg/m 2 to 100 mg/m 2 single agent ( 2.2 ) BC adjuvant: 75 mg/m 2 administered 1 hour after doxorubicin 50 mg/m 2 and cyclophosphamide 500 mg/m 2 every 3 weeks for 6 cycles ( 2.2 ) NSCLC: after platinum therapy failure: 75 mg/m 2 single agent ( 2.3 ) NSCLC: chemotherapy naive: 75 mg/m 2 followed by cisplatin 75 mg/m 2 ( 2.3 ) CRPC: 75 mg/m 2 with 5 mg prednisone twice a day continuously ( 2.4 ) GC: 75 mg/m 2 followed by cisplatin 75 mg/m 2 (both on day 1 only) followed by fluorouracil 750 mg/m 2 per day as a 24-hr IV (days 1-5), starting at end of cisplatin infusion ( 2.5 ) SCCHN: 75 mg/ m 2 followed by cisplatin 75 mg/m 2 IV (day 1), followed by fluorouracil 750 mg/m 2 per day as a 24-hr IV (days 1-5), starting at end of cisplatin infusion; for 4 cycles ( 2.6 ) SCCHN: 75 mg/m 2 followed by cisplatin 100 mg/m 2 IV (day 1), followed by fluorouracil 1000 mg/m 2 per day as a 24-hr IV (days 1-4); for 3 cycles ( 2.6 ) For all patients: Premedicate with oral corticosteroids ( 2.7 ) Adjust dose as needed ( 2.8 )
2.1Important Dosage and Administration Instructions Do not substitute BEIZRAY for or with other docetaxel products because BEIZRAY has different administration instructions from other docetaxel products. For all indications, toxicities may warrant dosage adjustments [see Dosage and Administration ( 2.8 )] . Administer in a facility equipped to manage possible complications (e.g. anaphylaxis).
See additional premedication recommendations for the indicated populations [ see Dosage and Administration ( 2.7 ) ]
2.2Recommended Dosage for Breast Cancer For locally advanced or metastatic breast cancer after failure of prior chemotherapy, the recommended dosage of BEIZRAY is 60 mg/m 2 to 100 mg/m 2 administered intravenously over 1 hour every 3 weeks. For the adjuvant treatment of operable node-positive breast cancer, the recommended BEIZRAY dosage is 75 mg/m 2 administered 1 hour after doxorubicin 50 mg/m 2 and cyclophosphamide 500 mg/m 2 every 3 weeks for 6 courses. Prophylactic G-CSF may be used to mitigate the risk of hematological toxicities [see Dosage and Administration ( 2.7 )] .
2.3Recommended Dosage for Non-small Cell Lung Cancer For treatment after failure of prior platinum-based chemotherapy, the recommended dosage of BEIZRAY monotherapy is 75 mg/m 2 administered intravenously over 1 hour every 3 weeks. In patients previously treated with chemotherapy, a dosage of 100 mg/m 2 is not recommended because this dosage was associated with increased hematologic toxicity, infection, and treatment-related mortality in randomized controlled trials [see Dosage and Administration ( 2.8 ), Warnings and Precautions ( 5 ), and Clinical Studies ( 14 )] .
For chemotherapy-naive patients, the recommended dosage of BEIZRAY is 75 mg/m 2 administered intravenously over 1 hour immediately followed by cisplatin 75 mg/m 2 over 30-60 minutes every 3 weeks [see Dosage and Administration ( 2.7 )] .
2.4Recommended Dosage for Prostate Cancer For metastatic castration-resistant prostate cancer, the recommended dosage of BEIZRAY is 75 mg/m 2 every 3 weeks as a 1-hour intravenous infusion. Recommend concomitant use of 5 mg of prednisone orally twice daily continuously [see Dosage and Administration ( 2.7 )] .
2.5Recommended Dosage for Gastric Adenocarcinoma For gastric adenocarcinoma, the recommended dosage of BEIZRAY is 75 mg/m 2 as a 1-hour intravenous infusion, followed by cisplatin 75 mg/m 2 , as a 1 to 3 hour intravenous infusion (both on day 1 only), followed by fluorouracil 750 mg/m 2 per day given as a 24-hour continuous intravenous infusion for 5 days, starting at the end of the cisplatin infusion. Repeat treatment every three weeks. Must receive premedication with antie… [Excerpted — this section continues on DailyMed.]
💊 Dosage Forms and Strengths ▾
3 DOSAGE FORMS AND STRENGTHS BEIZRAY (docetaxel) injection is a clear, colorless liquid supplied as follows: BEIZRAY 80 mg kit consisting of the following: One single-dose vial of BEIZRAY: 80 mg/4 mL One single-dose vial of IV Solution Stabilizer: 50 mL of 25% Albumin Human USP solution for infusion; a clear and slightly viscous solution BEIZRAY 160 mg kit consisting of the following: Two single-dose vials of BEIZRAY: 80 mg/4 mL each One single-dose vial of IV Solution Stabilizer: 50 mL of 25% Albumin Human USP solution for infusion; a clear and slightly viscous solution BEIZRAY carton containing one single-dose vial: 80 mg/4 mL 20 mg/mL BEIZRAY (docetaxel) injection is supplied as follows: BEIZRAY 80 mg kit contains: One single-dose vial of BEIZRAY: 80 mg/4 mL ( 3 ) One single-dose vial of IV Solution Stabilizer (50 mL, 25% Albumin Human USP solution) ( 3 ) BEIZRAY 160 mg kit contains: Two single-dose vials of BEIZRAY: 80 mg/4 mL each ( 3 ) One single-dose vial of IV Solution Stabilizer (50 mL, 25% Albumin Human USP solution) ( 3 ) BEIZRAY carton containing one single-dose vial: 80 mg/4 mL ( 3 ) 20 mg/mL ( 3 )
⛔ Contraindications ▾
4 CONTRAINDICATIONS BEIZRAY is contraindicated in patients with: neutrophil counts of <1500 cells/mm 3 [see Warnings and Precautions ( 5.3 )] . a history of severe hypersensitivity reactions to docetaxel. Severe reactions, including anaphylaxis, have occurred [see Warnings and Precautions ( 5.5 )] . Hypersensitivity to docetaxel ( 4 ) Neutrophil counts of <1500 cells/mm 3 ( 4 )
⚠️ Warnings and Cautions ▾
5 WARNINGS AND PRECAUTIONS Second primary malignancies: In patients treated with BEIZRAY-containing regimens, monitor for delayed AML, MDS, NHL, and renal cancer. ( 5.7 ) Cutaneous reactions: Reactions including erythema of the extremities with edema followed by desquamation may occur. Severe cutaneous adverse reactions have been reported.
Severe skin toxicity may require dose adjustment or permanent treatment discontinuation. ( 5.8 ) Neurologic reactions: Reactions including paresthesia, dysesthesia, and pain may occur. Severe neurosensory symptoms require dose adjustment or discontinuation if persistent.
( 5.9 ) Eye disorders: Cystoid macular edema (CME) has been reported and requires treatment discontinuation. ( 5.10 ) Asthenia: Severe asthenia may occur and may require treatment discontinuation. ( 5.11 ) Embryo-fetal toxicity: Can cause fetal harm.
Advise patients of the potential risk to a fetus and to use effective contraception. ( 5.12 , 8.1 , 8.3 ) Alcohol content: The alcohol content in a dose of BEIZRAY Injection may affect the central nervous system. This may include impairment of a patient's ability to drive or use machines immediately after infusion.
( 5.13 ) Tumor lysis syndrome: Tumor lysis syndrome has been reported. Patients at risk should be well hydrated and closely monitored during treatment. ( 5.14 ) BEIZRAY final infusion solution contains albumin derived from human blood, which has a theoretical risk of viral transmission.
( 5.15 )
5.1Toxic Deaths Breast Cancer BEIZRAY administered at 100 mg/m 2 was associated with deaths considered possibly or probably related to treatment in 2.0% (19/965) of metastatic breast cancer patients, both previously treated and untreated, with normal baseline liver function and in 11.5% (7/61) of patients with various tumor types who had abnormal baseline liver function (AST and/or ALT >1.5 times ULN together with AP >2.5 times ULN). Among patients dosed at 60 mg/m 2 , mortality related to treatment occurred in 0.6% (3/481) of patients with normal liver function, and in 3 of 7 patients with abnormal liver function.
Approximately half of these deaths occurred during the first cycle. Sepsis accounted for the majority of the deaths. Non-small Cell Lung Cancer BEIZRAY administered at a dose of 100 mg/m 2 in patients with locally advanced or metastatic non-small cell lung cancer who had a history of prior platinum-based chemotherapy was associated with increased treatment-related mortality (14% and 5% in two randomized, controlled studies).
There were 2.8% treatment-related deaths among the 176 patients treated at the 75 mg/m 2 dose in the randomized trials. Among patients who experienced treatment-related mortality at the 75 mg/m 2 dose level, 3 of 5 patients had an ECOG PS of 2 at study entry [see Dosage and Administration ( 2.2 ), Clinical Studies ( 14 )] .
5.2Hepatic Impairment Patients with elevations of bilirubin or abnormalities of transaminase concurrent with alkaline phosphatase are at increased risk for the development of severe neutropenia, febrile neutropenia, infections, severe thrombocytopenia, severe stomatitis, severe skin toxicity, and toxic death. Avoid BEIZRAY in patients with bilirubin > upper limit of normal (ULN), or to patients with AST and/or ALT >1.5 × ULN concomitant with alkaline phosphatase >2.5 × ULN [see Warnings and Precautions ( 5.1 )] . For patients with isolated elevations of transaminase >1.5 × ULN, consider BEIZRAY dose modifications [see Dosage and Administration ( 2.7 )] .
Measure bilirubin, AST or ALT, and alkaline phosphatase prior to each cycle of BEIZRAY therapy.
5.3Hematologic Effects Perform frequent peripheral blood cell counts on all patients receiving BEIZRAY. Do not retreat patients with subsequent cycles of BEIZRAY until neutrophils recover to a level >1500 cells/mm 3 [see Contraindications ( 4 )] . Avoid retreating patients until platelets recover to a level >100,000 cells/mm 3 . A 25% reduction in the dose of BEIZRAY is recommen… [Excerpted — this section continues on DailyMed.]
🤒 Adverse Reactions ▾
6 ADVERSE REACTIONS The most serious adverse reactions from BEIZRAY are: Toxic Deaths [see Boxed Warning, Warnings and Precautions ( 5.1 )] Hepatic Impairment [see Boxed Warning, Warnings and Precautions ( 5.2 )] Hematologic Effects [see Boxed Warning, Warnings and Precautions ( 5.3 )] Enterocolitis and Neutropenic Colitis [see Warnings and Precautions ( 5.4 )] Hypersensitivity Reactions [see Boxed Warning, Warnings and Precautions ( 5.5 )] Fluid Retention [see Boxed Warning, Warnings and Precautions ( 5.6 )] Second Primary Malignancies [see Warnings and Precautions ( 5.7 )] Cutaneous Reactions [see Warnings and Precautions ( 5.8 )] Neurologic Reactions [see Warnings and Precautions ( 5.9 )] Eye Disorders [see Warnings and Precautions ( 5.10 )] Asthenia [see Warnings and Precautions ( 5.11 )] Alcohol Content [see Warnings and Precautions ( 5.13 )] Tumor Lysis Syndrome [see Warnings and Precautions ( 5.14 )] The most common adverse reactions across all docetaxel indications are infections, neutropenia, anemia, febrile neutropenia, hypersensitivity, thrombocytopenia, neuropathy, dysgeusia, dyspnea, constipation, anorexia, nail disorders, fluid retention, asthenia, pain, nausea, diarrhea, vomiting, mucositis, alopecia, skin reactions, and myalgia.
Incidence varies depending on the indication. Adverse reactions are described according to indication. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
Responding patients may not experience an improvement in performance status on therapy and may experience worsening. The relationship between changes in performance status, response to therapy, and treatment-related side effects has not been established. Most common adverse reactions across all BEIZRAY indications are infections, neutropenia, anemia, febrile neutropenia, hypersensitivity, thrombocytopenia, neuropathy, dysgeusia, dyspnea, constipation, anorexia, nail disorders, fluid retention, asthenia, pain, nausea, diarrhea, vomiting, mucositis, alopecia, skin reactions, and myalgia.
( 6 ) To report SUSPECTED ADVERSE REACTIONS, contact Zydus Pharmaceuticals (USA) Inc. at 1-877-993-8779 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
6.1Clinical Trials Experience Breast Cancer Monotherapy with docetaxel for locally advanced or metastatic breast cancer after failure of prior chemotherapy Docetaxel 100 mg/m 2 : Adverse drug reactions occurring in at least 5% of patients are compared for three populations who received docetaxel administered at 100 mg/m 2 as a 1-hour infusion every 3 weeks: 2045 patients with various tumor types and normal baseline liver function tests; the subset of 965 patients with locally advanced or metastatic breast cancer, both previously treated and untreated with chemotherapy, who had normal baseline liver function tests; and an additional 61 patients with various tumor types who had abnormal liver function tests at baseline.
These reactions were described using COSTART terms and were considered possibly or probably related to docetaxel. At least 95% of these patients did not receive hematopoietic support. The safety profile is generally similar in patients receiving docetaxel for the treatment of breast cancer and in patients with other tumor types.
(See Table 4.) Table 4: Summary of Adverse Reactions in Patients Receiving Docetaxel at 100 mg/m 2 *Normal Baseline LFTs: Transaminases ≤1.5 times ULN or alkaline phosphatase ≤2.5 times ULN or isolated elevations of transaminases or alkaline phosphatase up to 5 times ULN **Elevated Baseline LFTs: AST and/or AL >1.5 times ULN concurrent with alkaline phosphatase >2.5 times ULN ***Febrile Neutropenia: ANC grade 4 with fever >38°C with intravenous antibiotics and/or hospitalization Adverse Reaction All Tumor Types Normal LFTs* n=2045 % All Tumor Types Elevat… [Excerpted — this section continues on DailyMed.]
🔄 Drug Interactions ▾
7 DRUG INTERACTIONS Docetaxel is a CYP3A4 substrate. In vitro studies have shown that the metabolism of docetaxel may be modified by the concomitant administration of compounds that induce, inhibit, or are metabolized by cytochrome P450 3A4. In vivo studies showed that the exposure of docetaxel increased 2.2-fold when it was coadministered with ketoconazole, a potent inhibitor of CYP3A4.
Protease inhibitors, particularly ritonavir, may increase the exposure of docetaxel. Concomitant use of BEIZRAY and drugs that inhibit CYP3A4 may increase exposure to docetaxel and should be avoided. In patients receiving treatment with BEIZRAY, close monitoring for toxicity and a BEIZRAY dose reduction could be considered if systemic administration of a potent CYP3A4 inhibitor cannot be avoided [see Dosage and Administration ( 2.7 ), Clinical Pharmacology ( 12.3 )] .
Cytochrome P450 3A4 inducers, inhibitors, or substrates: May alter docetaxel metabolism. ( 7 )
👥 Use in Specific Populations ▾
8 USE IN SPECIFIC POPULATIONS Lactation: Advise women not to breastfeed. ( 8.2 ) Females and Males of Reproductive Potential: Verify pregnancy status of females prior to initiation of BEIZRAY. ( 8.3 )
8.1Pregnancy Risk Summary Based on findings in animal reproduction studies and its mechanism of action, BEIZRAY can cause fetal harm when administered to a pregnant woman [see Clinical Pharmacology ( 12.1 )] . Available data from case reports in the literature and pharmacovigilance with docetaxel use in pregnant women are not sufficient to inform the drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. BEIZRAY contains alcohol which can interfere with neurobehavioral development [see Clinical Considerations] .
In animal reproductive studies, administration of docetaxel to pregnant rats and rabbits during the period of organogenesis caused an increased incidence of embryo-fetal toxicities, including intrauterine mortality, at doses as low as 0.02 and 0.003 times the recommended human dose based on body surface area, respectively [see Data] . Advise pregnant women and females of reproductive potential of the potential risk to a fetus. The estimated background risk of major birth defects and miscarriage for the indicated populations is unknown.
All pregnancies have a background risk of birth defect, miscarriage, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. Clinical Considerations BEIZRAY contains alcohol [see Warnings and Precautions ( 5.13 )] .
Published studies have demonstrated that alcohol is associated with fetal harm including central nervous system abnormalities, behavioral disorders, and impaired intellectual development. Data Animal data Intravenous administration of ≥ 0.3 and 0.03 mg/kg/day docetaxel to pregnant rats and rabbits, respectively, during the period of organogenesis caused an increased incidence of intrauterine mortality, resorptions, reduced fetal weights, and fetal ossification delays. Maternal toxicity was also observed at these doses, which were approximately 0.02 and 0.003 times the daily maximum recommended human dose based on body surface area, respectively.
8.2Lactation Risk Summary There is no information regarding the presence of docetaxel in human milk, or on its effects on milk production or the breastfed child. No lactation studies in animals have been conducted. Because of the potential for serious adverse reactions in a breastfed child, advise women not to breastfeed during treatment with BEIZRAY and for 1 week after the last dose.
8.3Females and Males of Reproductive Potential Based on findings in animals, BEIZRAY can cause fetal harm when administered to a pregnant woman [see Use in Specific Populations ( 8.1 )] . Pregnancy Testing Verify pregnancy status in females of reproductive potential prior to initiating BEIZRAY. Contraception Females Based on genetic toxicity findings, advise females of reproductive potential to use effective contraception during treatment and for 2 months after the last dose of BEIZRAY.
Males Based on genetic toxicity findings, advise male patients with female partners of reproductive potential to use effective contraception during treatment and for 4 months after the last dose of BEIZRAY. Infertility Based on findings in animal studies, BEIZRAY may impair fertility in males of reproductive potential [see Nonclinical Toxicology ( 13.1 )] .
8.4Pediatric Use The alcohol content of BEIZRAY Injection should be taken into account when given to pediatric patients [see Warnings and Precautions ( 5.13 )] . The efficacy of BEIZRAY in pediatric patients as monotherapy or in combination has not been established. The overall safety profile of BEIZRAY in pediatric patients receiving monotherapy or TCF was consistent with the known safety profile in adults.
Docetaxel has been… [Excerpted — this section continues on DailyMed.]
🤰 Pregnancy ▾
8.1Pregnancy Risk Summary Based on findings in animal reproduction studies and its mechanism of action, BEIZRAY can cause fetal harm when administered to a pregnant woman [see Clinical Pharmacology ( 12.1 )] . Available data from case reports in the literature and pharmacovigilance with docetaxel use in pregnant women are not sufficient to inform the drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. BEIZRAY contains alcohol which can interfere with neurobehavioral development [see Clinical Considerations] .
In animal reproductive studies, administration of docetaxel to pregnant rats and rabbits during the period of organogenesis caused an increased incidence of embryo-fetal toxicities, including intrauterine mortality, at doses as low as 0.02 and 0.003 times the recommended human dose based on body surface area, respectively [see Data] . Advise pregnant women and females of reproductive potential of the potential risk to a fetus. The estimated background risk of major birth defects and miscarriage for the indicated populations is unknown.
All pregnancies have a background risk of birth defect, miscarriage, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. Clinical Considerations BEIZRAY contains alcohol [see Warnings and Precautions ( 5.13 )] .
Published studies have demonstrated that alcohol is associated with fetal harm including central nervous system abnormalities, behavioral disorders, and impaired intellectual development. Data Animal data Intravenous administration of ≥ 0.3 and 0.03 mg/kg/day docetaxel to pregnant rats and rabbits, respectively, during the period of organogenesis caused an increased incidence of intrauterine mortality, resorptions, reduced fetal weights, and fetal ossification delays. Maternal toxicity was also observed at these doses, which were approximately 0.02 and 0.003 times the daily maximum recommended human dose based on body surface area, respectively.
🧒 Pediatric Use ▾
8.4Pediatric Use The alcohol content of BEIZRAY Injection should be taken into account when given to pediatric patients [see Warnings and Precautions ( 5.13 )] . The efficacy of BEIZRAY in pediatric patients as monotherapy or in combination has not been established. The overall safety profile of BEIZRAY in pediatric patients receiving monotherapy or TCF was consistent with the known safety profile in adults.
Docetaxel has been studied in a total of 289 pediatric patients: 239 in 2 trials with monotherapy and 50 in combination treatment with cisplatin and 5-fluorouracil (TCF). Docetaxel Monotherapy Docetaxel monotherapy was evaluated in a dose-finding phase 1 trial in 61 pediatric patients (median age 12.5 years, range 1-22 years) with a variety of refractory solid tumors. The recommended dose was 125 mg/m 2 as a 1-hour intravenous infusion every 21 days.
The primary dose limiting toxicity was neutropenia. The recommended dose for docetaxel monotherapy was evaluated in a phase 2 single-arm trial in 178 pediatric patients (median age 12 years, range 1-26 years) with a variety of recurrent/refractory solid tumors. Efficacy was not established with tumor response rates ranging from one complete response (CR) (0.6%) in a patient with undifferentiated sarcoma to four partial responses (2.2%) seen in one patient each with Ewing Sarcoma, neuroblastoma, osteosarcoma, and squamous cell carcinoma.
Docetaxel in Combination Docetaxel was studied in combination with cisplatin and 5-fluorouracil (TCF) versus cisplatin and 5-fluorouracil (CF) for the induction treatment of nasopharyngeal carcinoma (NPC) in pediatric patients prior to chemoradiation consolidation. Seventy-five patients (median age 16 years, range 9 to 21 years) were randomized (2:1) to docetaxel (75 mg/m 2 ) in combination with cisplatin (75 mg/m 2 ) and 5-fluorouracil (750 mg/m 2 ) (TCF) or to cisplatin (80 mg/m 2 ) and 5-fluorouracil (1000 mg/m 2 /day) (CF).
The primary endpoint was the CR rate following induction treatment of NPC. One patient out of 50 in the TCF group (2%) had a complete response while none of the 25 patients in the CF group had a complete response. Pharmacokinetics Pharmacokinetic parameters for docetaxel were determined in 2 pediatric solid tumor trials.
Following docetaxel administration at 55 mg/m 2 to 235 mg/m 2 in a 1-hour intravenous infusion every 3 weeks in 25 patients aged 1 to 20 years (median 11 years), docetaxel clearance was 17.3±10.9 L/h/m 2 . Docetaxel was administered in combination with cisplatin and 5-fluorouracil (TCF), at dose levels of 75 mg/m2 in a 1-hour intravenous infusion day 1 in 28 patients aged 10 to 21 years (median 16 years, 17 patients were older than 16). Docetaxel clearance was 17.9±8.75 L/h/m2, corresponding to an AUC of 4.20±2.57 μg∙h/mL.
In summary, the body surface area adjusted clearance of docetaxel monotherapy and TCF combination in children were comparable to those in adults [see Clinical Pharmacology ( 12.3 )].
🧓 Geriatric Use ▾
8.5Geriatric Use In general, dose selection for an elderly patient should be cautious, reflecting the greater frequency of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy in elderly patients. Non-small Cell Lung Cancer In a study conducted in chemotherapy-naive patients with NSCLC (TAX326), 148 patients (36%) in the docetaxel+cisplatin group were 65 years of age or greater. There were 128 patients (32%) in the vinorelbine+cisplatin group 65 years of age or greater.
In the docetaxel+cisplatin group, patients less than 65 years of age had a median survival of 10.3 months (95% CI: 9.1 months, 11.8 months) and patients 65 years or older had a median survival of 12.1 months (95% CI: 9.3 months, 14 months). In patients 65 years of age or greater treated with docetaxel+cisplatin, diarrhea (55%), peripheral edema (39%) and stomatitis (28%) were observed more frequently than in the vinorelbine+cisplatin group (diarrhea 24%, peripheral edema 20%, stomatitis 20%). Patients treated with docetaxel+cisplatin who were 65 years of age or greater were more likely to experience diarrhea (55%), infections (42%), peripheral edema (39%) and stomatitis (28%) compared to patients less than the age of 65 administered the same treatment (43%, 31%, 31% and 21%, respectively).
When docetaxel was combined with carboplatin for the treatment of chemotherapy-naive, advanced non-small cell lung carcinoma, patients 65 years of age or greater (28%) experienced higher frequency of infection compared to similar patients treated with docetaxel+cisplatin, and a higher frequency of diarrhea, infection and peripheral edema than elderly patients treated with vinorelbine+cisplatin. Prostate Cancer Of the 333 patients treated with docetaxel every three weeks plus prednisone in the prostate cancer study (TAX327), 209 patients were 65 years of age or greater and 68 patients were older than 75 years.
In patients treated with docetaxel every three weeks, the following treatment-emergent adverse reactions occurred at rates ≥10% higher in patients 65 years of age or greater compared to younger patients: anemia (71% vs 59%), infection (37% vs 24%), nail changes (34% vs 23%), anorexia (21% vs 10%), weight loss (15% vs 5%), respectively. Breast Cancer In the adjuvant breast cancer trial (TAX316), docetaxel in combination with doxorubicin and cyclophosphamide was administered to 744 patients of whom 48 (6%) were 65 years of age or greater.
The number of elderly patients who received this regimen was not sufficient to determine whether there were differences in safety and efficacy between elderly and younger patients. Gastric Cancer Among the 221 patients treated with docetaxel in combination with cisplatin and fluorouracil in the gastric cancer study, 54 were 65 years of age or older and 2 patients were older than 75 years. In this study, the number of patients who were 65 years of age or older was insufficient to determine whether they respond differently from younger patients.
However, the incidence of serious adverse reactions was higher in the elderly patients compared to younger patients. The incidence of the following adverse reactions (all grades, regardless of relationship): lethargy, stomatitis, diarrhea, dizziness, edema, febrile neutropenia/neutropenic infection occurred at rates ≥10% higher in patients who were 65 years of age or older compared to younger patients. Elderly patients treated with TCF should be closely monitored.
Head and Neck Cancer Among the 174 and 251 patients who received the induction treatment with docetaxel in combination with cisplatin and fluorouracil (TPF) for SCCHN in the TAX323 and TAX324 studies, 18 (10%) and 32 (13%) of the patients were 65 years of age or older, respectively. These clinical studies of docetaxel in combination with cisplatin and fluorouracil in patients with SCCHN did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently fr… [Excerpted — this section continues on DailyMed.]
🆘 Overdosage ▾
10 OVERDOSAGE There is no known antidote for BEIZRAY overdosage. In case of overdosage, the patient should be kept in a specialized unit where vital functions can be closely monitored. Anticipated complications of overdosage include: bone marrow suppression, peripheral neurotoxicity, and mucositis.
Patients should receive therapeutic G-CSF as soon as possible after discovery of overdose. Other appropriate symptomatic measures should be taken, as needed. In two reports of overdose, one patient received 150 mg/m 2 and the other received 200 mg/m 2 as 1-hour infusions.
Both patients experienced severe neutropenia, mild asthenia, cutaneous reactions, and mild paresthesia, and recovered without incident. In mice, lethality was observed following single intravenous doses that were ≥154 mg/kg (about 4.5 times the human dose of 100 mg/m 2 on a mg/m 2 basis); neurotoxicity associated with paralysis, non-extension of hind limbs, and myelin degeneration was observed in mice at 48 mg/kg (about 1.5 times the human dose of 100 mg/m 2 basis). In male and female rats, lethality was observed at a dose of 20 mg/kg (comparable to the human dose of 100 mg/m 2 on a mg/m 2 basis) and was associated with abnormal mitosis and necrosis of multiple organs.
🧬 Clinical Pharmacology ▾
12 CLINICAL PHARMACOLOGY
12.1Mechanism of Action Docetaxel is an antineoplastic agent that acts by disrupting the microtubular network in cells that is essential for mitotic and interphase cellular functions. Docetaxel binds to free tubulin and promotes the assembly of tubulin into stable microtubules while simultaneously inhibiting their disassembly. This leads to the production of microtubule bundles without normal function and to the stabilization of microtubules, which results in the inhibition of mitosis in cells.
Docetaxel's binding to microtubules does not alter the number of protofilaments in the bound microtubules, a feature which differs from most spindle poisons currently in clinical use.
12.2Pharmacodynamics Docetaxel exposure-response relationships and the time course of pharmacodynamic response are unknown.
12.3Pharmacokinetics Absorption The pharmacokinetics of docetaxel has been evaluated in cancer patients after administration of 20 mg/m 2 to 115 mg/m 2 in phase 1 studies. The area under the curve (AUC) was dose proportional following doses of 70 mg/m 2 to 115 mg/m 2 with infusion times of 1 to 2 hours. Docetaxel's pharmacokinetic profile is consistent with a three-compartment pharmacokinetic model, with initial rapid distribution phase and the late (terminal) phase.
Distribution Mean steady state volume of distribution was 113 L. Docetaxel is approximately 94% protein bound in vitro , mainly to α1-acid glycoprotein, albumin, and lipoproteins. In three cancer patients, the in vitro binding to plasma proteins was approximately 97%.
Dexamethasone does not affect the protein binding of docetaxel. Elimination With extended plasma sampling up to 8 to 22 days post infusion, the estimated mean total body clearance was 18 L/h/m 2 (range of means: 14 to 23) and mean terminal elimination half-life was 116 hours (range of means: 92 to 135). Metabolism Docetaxel is metabolized by the CYP3A4 isoenzyme in vitro [see Drug Interactions ( 7 )] .
Excretion In three cancer patients urinary and fecal excretion accounted for approximately 6% and 75% of the administered radioactivity, respectively, within 7 days. About 80% of the radioactivity recovered in feces was excreted during the first 48 hours as 1 major and 3 minor metabolites with less than 8% as unchanged drug. Specific Populations Effect of Age: A population pharmacokinetic analysis was carried out after docetaxel treatment of 535 patients dosed at 100 mg/m 2 .
Pharmacokinetic parameters estimated by this analysis were very close to those estimated from phase 1 studies. The pharmacokinetics of docetaxel was not influenced by age. Effect of Gender: The population pharmacokinetics analysis described above also indicated that gender did not influence the pharmacokinetics of docetaxel.
Hepatic Impairment: The population pharmacokinetic analysis described above indicated that in patients with clinical chemistry data suggestive of mild to moderate liver impairment (AST and/or ALT >1.5 times ULN concomitant with alkaline phosphatase >2.5 times ULN), total body clearance was lowered by an average of 27%, resulting in a 38% increase in systemic exposure (AUC). This average, however, includes a substantial range and there is, at present, no measurement that would allow recommendation for dose adjustment in such patients.
Patients with combined abnormalities of transaminase and alkaline phosphatase should not be treated with docetaxel. Patients with severe hepatic impairment have not been studied [see Warnings and Precautions ( 5.2 ), Use in Specific Populations ( 8.6 )] . Effect of Race: Mean total body clearance for Japanese patients dosed at the range of 10 mg/m 2 to 90 mg/m 2 was similar to that of European/American populations dosed at 100 mg/m 2 , suggesting no significant difference in the elimination of docetaxel in the two populations.
Drug Interaction Studies Effect of Ketoconazole: The effect of ketoconazole (a strong CYP3A4 inhibitor) on the pharmacokinetics of docet… [Excerpted — this section continues on DailyMed.]
🧬 Mechanism of Action ▾
12.1Mechanism of Action Docetaxel is an antineoplastic agent that acts by disrupting the microtubular network in cells that is essential for mitotic and interphase cellular functions. Docetaxel binds to free tubulin and promotes the assembly of tubulin into stable microtubules while simultaneously inhibiting their disassembly. This leads to the production of microtubule bundles without normal function and to the stabilization of microtubules, which results in the inhibition of mitosis in cells.
Docetaxel's binding to microtubules does not alter the number of protofilaments in the bound microtubules, a feature which differs from most spindle poisons currently in clinical use.
📦 How Supplied / Storage and Handling ▾
16 HOW SUPPLIED/STORAGE AND HANDLING
16.1How Supplied BEIZRAY injection is a clear, colorless liquid supplied as follows: Co-packaged kit containing BEIZRAY vial(s) and IV Solution Stabilizer (25% Albumin Human USP), a clear and slightly viscous solution Carton containing one BEIZRAY vial only Package Configuration BEIZRAY Strength Carton Contents NDC Number 80 mg kit 80 mg/4 mL one single-dose vial of 80 mg/4 mL BEIZRAY injection (NDC 70710-2090-1). one single-dose vial of 50 mL of 25% Albumin Human USP solution (NDC 64208-2512-4). NDC 70710-2091-3 160 mg kit 80 mg/4 mL two single-dose vials of 80 mg/4 mL BEIZRAY injection (NDC 70710-2090-1). one single-dose vial of 50 mL of 25% Albumin Human USP solution (NDC 64208-2512-4).
NDC 70710-2093-4 20 mg/mL vial 20 mg/mL one single-dose vial of 20 mg/mL BEIZRAY injection. (NDC 70710-2092-1) NDC 70710-2092-8 80 mg/4 mL vial 80 mg/4 mL One single-dose vial of 80 mg/4 mL BEIZRAY injection. (70710-2090-1) NDC 70710-2152-1
16.2Storage BEIZRAY Injection and 25% Albumin Human USP (IV Solution Stabilizer): Store at 20°C to 25°C (68°F to 77°F). Excursions permitted from 15°C to 30°C (59°F to 86°F). [see USP controlled room temperature]. Retain in the original package to protect from light. Protect from freezing.
16.3Handling and Disposal BEIZRAY is a hazardous drug. Follow applicable special handling and disposal procedures.
📋 Description ▾
11 DESCRIPTION Docetaxel is an antineoplastic agent belonging to the taxoid family. The chemical name for docetaxel is (2R,3S)-N-carboxy-3-phenylisoserine,N-tert-butyl ester, 13-ester with 5β, 20-epoxy-1,2α,4,7β,10β,13α-hex-ahydroxytax-11-en-9-one 4-acetate 2-benzoate. Docetaxel has the following structural formula: Docetaxel is a white to almost-white powder with an empirical formula of C 43 H 53 NO 14 , and a molecular weight of 807.89.
It is highly lipophilic and practically insoluble in water. BEIZRAY Injection for intravenous use is a sterile, non-pyrogenic, clear colorless liquid at 20 mg/mL concentration. Each mL contains 20 mg docetaxel (anhydrous) in 0.770 grams dehydrated alcohol (100% v/v) solution, with citric acid for pH adjustment.
The BEIZRAY kit also contains a single dose vial of IV Solution Stabilizer, 50 mL of 25% Albumin Human USP solution. 25% Albumin Human USP is a clear, slightly viscous liquid; it is almost colorless or slightly yellow or green. The product contains 0.25 g Albumin Human USP per mL and is stabilized with 0.08 mmol sodium acetyltryptophanate and 0.08 mmol sodium caprylate per gram of albumin.
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💬 Information for Patients ▾
17 PATIENT COUNSELING INFORMATION Advise the patient to read the FDA-approved patient labeling (Patient Information). Bone Marrow Suppression Advise patients that periodic assessment of their blood count will be performed to detect neutropenia, thrombocytopenia, and/ or anemia [see Contraindications ( 4 ), Warnings and Precautions ( 5.3 )] . Instruct patients to monitor their temperature frequently and immediately report any occurrence of fever.
Enterocolitis and Neutropenic Colitis Advise patients of the symptoms of colitis, such as abdominal pain or tenderness, and/or diarrhea, with or without fever, and instruct patients to promptly contact their healthcare provider if they experience these symptoms [see Dosage and Administration ( 2.7 ) and Warnings and Precautions ( 5.4 )] . Hypersensitivity Reactions Ask patients whether they have previously received paclitaxel therapy, and if they have experienced a hypersensitivity reaction to paclitaxel. Instruct patients to immediately report to their healthcare provider signs of a hypersensitivity reaction [see Contraindications ( 4 ), Warnings and Precautions ( 5.5 )] .
Fluid Retention Advise patients to report signs of fluid retention such as peripheral edema in the lower extremities, weight gain, and dyspnea immediately to their healthcare provider [see Warnings and Precautions ( 5.6 )] . Second Primary Malignancies Advise patients on the risk of second primary malignancies during treatment with BEIZRAY [see Warnings and Precautions ( 5.7 )] . Cutaneous Reactions Advise patients that localized erythema of the extremities and severe skin toxicities may occur.
Instruct patients to immediately report severe cutaneous reactions to their healthcare provider [see Dosage and Administration ( 2.7 ) and Warnings and Precautions ( 5.8 )] . Neurologic Reactions Advise patients that neurosensory symptoms or peripheral neuropathy may occur. Instruct patients to immediately report neurologic reactions to their healthcare provider [see Dosage and Administration ( 2.7 ) and Warnings and Precautions ( 5.9 )] .
Eye Disorders Advise patients that vision disturbances and excessive tearing are associated with BEIZRAY administration. Instruct patients to immediately report any vision changes to their healthcare provider [see Warnings and Precautions ( 5.10 )] . Gastrointestinal Reactions Explain to patients that nausea, vomiting, diarrhea, and constipation are associated with BEIZRAY administration.
Instruct patients to report any severe events to their healthcare provider [see Adverse Reactions ( 6 )] . Cardiac Disorders Advise patients to report any irregular and/or rapid heartbeat, severe shortness of breath, dizziness, and/or fainting immediately to their healthcare provider [see Adverse Reactions ( 6 )] . Other Common Adverse Reactions Advise patients that other common adverse reactions associated with BEIZRAY may include alopecia (cases of permanent hair loss have been reported), asthenia, anorexia, dysgeusia, mucositis, myalgia, nail disorders, or pain.
Instruct patients to report these reactions to their healthcare provider if serious events occur [see Adverse Reactions ( 6 )] . Importance of Corticosteroids Explain the significance of oral corticosteroids such as dexamethasone administration to the patient to help facilitate compliance. Instruct patients to report to their healthcare provider if they were not compliant with the oral corticosteroid regimen [see Dosage and Administration ( 2.6 )] .
Embryo-Fetal Toxicity BEIZRAY can cause fetal harm. Advise patients to inform their healthcare provider of a known or suspected pregnancy. Advise patients to avoid becoming pregnant while receiving this drug.
Advise female patients of reproductive potential to use effective contraceptives during treatment and for 2 months after the last dose of BEIZRAY. Advise male patients with female partners of reproductive potential to use effective contraception during treatment and for 4 months after the last d… [Excerpted — this section continues on DailyMed.]
🧬 Pharmacokinetics ▾
12.3Pharmacokinetics Absorption The pharmacokinetics of docetaxel has been evaluated in cancer patients after administration of 20 mg/m 2 to 115 mg/m 2 in phase 1 studies. The area under the curve (AUC) was dose proportional following doses of 70 mg/m 2 to 115 mg/m 2 with infusion times of 1 to 2 hours. Docetaxel's pharmacokinetic profile is consistent with a three-compartment pharmacokinetic model, with initial rapid distribution phase and the late (terminal) phase.
Distribution Mean steady state volume of distribution was 113 L. Docetaxel is approximately 94% protein bound in vitro , mainly to α1-acid glycoprotein, albumin, and lipoproteins. In three cancer patients, the in vitro binding to plasma proteins was approximately 97%.
Dexamethasone does not affect the protein binding of docetaxel. Elimination With extended plasma sampling up to 8 to 22 days post infusion, the estimated mean total body clearance was 18 L/h/m 2 (range of means: 14 to 23) and mean terminal elimination half-life was 116 hours (range of means: 92 to 135). Metabolism Docetaxel is metabolized by the CYP3A4 isoenzyme in vitro [see Drug Interactions ( 7 )] .
Excretion In three cancer patients urinary and fecal excretion accounted for approximately 6% and 75% of the administered radioactivity, respectively, within 7 days. About 80% of the radioactivity recovered in feces was excreted during the first 48 hours as 1 major and 3 minor metabolites with less than 8% as unchanged drug. Specific Populations Effect of Age: A population pharmacokinetic analysis was carried out after docetaxel treatment of 535 patients dosed at 100 mg/m 2 .
Pharmacokinetic parameters estimated by this analysis were very close to those estimated from phase 1 studies. The pharmacokinetics of docetaxel was not influenced by age. Effect of Gender: The population pharmacokinetics analysis described above also indicated that gender did not influence the pharmacokinetics of docetaxel.
Hepatic Impairment: The population pharmacokinetic analysis described above indicated that in patients with clinical chemistry data suggestive of mild to moderate liver impairment (AST and/or ALT >1.5 times ULN concomitant with alkaline phosphatase >2.5 times ULN), total body clearance was lowered by an average of 27%, resulting in a 38% increase in systemic exposure (AUC). This average, however, includes a substantial range and there is, at present, no measurement that would allow recommendation for dose adjustment in such patients.
Patients with combined abnormalities of transaminase and alkaline phosphatase should not be treated with docetaxel. Patients with severe hepatic impairment have not been studied [see Warnings and Precautions ( 5.2 ), Use in Specific Populations ( 8.6 )] . Effect of Race: Mean total body clearance for Japanese patients dosed at the range of 10 mg/m 2 to 90 mg/m 2 was similar to that of European/American populations dosed at 100 mg/m 2 , suggesting no significant difference in the elimination of docetaxel in the two populations.
Drug Interaction Studies Effect of Ketoconazole: The effect of ketoconazole (a strong CYP3A4 inhibitor) on the pharmacokinetics of docetaxel was investigated in 7 cancer patients. Patients were randomized to receive either docetaxel (100 mg/m 2 intravenous) alone or docetaxel (10 mg/m 2 intravenous) in combination with ketoconazole (200 mg orally once daily for 3 days) in a crossover design with a 3-week washout period. The results of this study indicated that the mean dose-normalized AUC of docetaxel was increased 2.2-fold and its clearance was reduced by 49% when docetaxel was coadministered with ketoconazole [see Dosage and Administration ( 2.7 ), Drug Interactions ( 7 )] .
Effect of combination therapies Dexamethasone: Docetaxel total body clearance was not modified by pretreatment with dexamethasone. Cisplatin: Clearance of docetaxel in combination therapy with cisplatin was similar to that previously observed following monotherapy with docetaxel. The… [Excerpted — this section continues on DailyMed.]
🧬 Pharmacodynamics ▾
12.2Pharmacodynamics Docetaxel exposure-response relationships and the time course of pharmacodynamic response are unknown.
🔬 Clinical Studies ▾
14 CLINICAL STUDIES
14.1Locally Advanced or Metastatic Breast Cancer The efficacy and safety of docetaxel have been evaluated in locally advanced or metastatic breast cancer after failure of previous chemotherapy (alkylating agent–containing regimens or anthracycline-containing regimens). Randomized Trials In one randomized trial, patients with a history of prior treatment with an anthracycline-containing regimen were assigned to treatment with docetaxel (100 mg/m 2 every 3 weeks) or the combination of mitomycin (12 mg/m 2 every 6 weeks) and vinblastine (6 mg/m 2 every 3 weeks).
Two hundred three patients were randomized to docetaxel and 189 to the comparator arm. Most patients had received prior chemotherapy for metastatic disease; only 27 patients on the docetaxel arm and 33 patients on the comparator arm entered the study following relapse after adjuvant therapy. Three-quarters of patients had measurable, visceral metastases.
The primary endpoint was time to progression. The following table summarizes the study results. (See Table 13.) Table 13: Efficacy of Docetaxel in the Treatment of Breast Cancer Patients Previously Treated with an Anthracycline-Containing Regimen (Intent-to-Treat Analysis) *For the risk ratio, a value less than 1.00 favors docetaxel.
Efficacy Parameter Docetaxel (n=203) Mitomycin/ Vinblastine (n=189) p-value Median Survival 11.4 months 8.7 months p=0.01 Log Rank Risk Ratio*, Mortality (Docetaxel: Control) 0.73 95% CI (Risk Ratio) 0.58-0.93 Median Time to Progression 4.3 months 2.5 months p=0.01 Log Rank Risk Ratio*, Progression (Docetaxel: Control) 0.75 95% CI (Risk Ratio) 0.61-0.94 Overall Response Rate 28.1% 9.5% p<0.0001 Chi Square Complete Response Rate 3.4% 1.6% In a second randomized trial, patients previously treated with an alkylating-containing regimen were assigned to treatment with docetaxel (100 mg/m 2 ) or doxorubicin (75 mg/m 2 ) every 3 weeks.
One hundred sixty-one patients were randomized to docetaxel and 165 patients to doxorubicin. Approximately one-half of patients had received prior chemotherapy for metastatic disease, and one-half entered the study following relapse after adjuvant therapy. Three-quarters of patients had measurable, visceral metastases.
The primary endpoint was time to progression. The study results are summarized below. (See Table 14.) Table 14: Efficacy of Docetaxel in the Treatment of Breast Cancer Patients Previously Treated with an Alkylating-Containing Regimen (Intent-to-Treat Analysis) Efficacy Parameter Docetaxel (n=161) Doxorubicin (n=165) p-value Median Survival 14.7 months 14.3 months p=0.39 Log Rank Risk Ratio*, Mortality (Docetaxel: Control) 0.89 95% CI (Risk Ratio) 0.68-1.16 Median Time to Progression 6.5 months 5.3 months p=0.45 Log Rank Risk Ratio*, Progression (Docetaxel: Control) 0.93 95% CI (Risk Ratio) 0.71-1.16 Overall Response Rate 45.3% 29.7% p=0.004 Chi Square Complete Response Rate 6.8% 4.2% *For the risk ratio, a value less than 1.00 favors docetaxel.
In another multicenter open-label, randomized trial (TAX313), in the treatment of patients with advanced breast cancer who progressed or relapsed after one prior chemotherapy regimen, 527 patients were randomized to receive docetaxel monotherapy 60 mg/m 2 (n=151), 75 mg/m 2 (n=188) or 100 mg/m 2 (n=188). In this trial, 94% of patients had metastatic disease and 79% had received prior anthracycline therapy. Response rate was the primary endpoint.
Response rates increased with docetaxel dose: 19.9% for the 60 mg/m 2 group compared to 22.3% for the 75 mg/m 2 and 29.8% for the 100 mg/m 2 group; pair-wise comparison between the 60 mg/m 2 and 100 mg/m 2 groups was statistically significant (p=0.037). Single Arm Studies Docetaxel at a dose of 100 mg/m 2 was studied in six single arm studies involving a total of 309 patients with metastatic breast cancer in whom previous chemotherapy had failed. Among these, 190 patients had anthracycline-resistant breast cancer, defined as progression during an anth… [Excerpted — this section continues on DailyMed.]
🧪 Nonclinical Toxicology ▾
13 NONCLINICAL TOXICOLOGY
13.1Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenicity studies with docetaxel have not been performed. Docetaxel was genotoxic by an aneugenic mechanism in the in vitro chromosome aberration test in CHO-K 1 cells and in the in vivo micronucleus test in mice administered doses of 0.39 to 1.56 mg/kg (about 1/60 th to 1/15 th the recommended human dose on a mg/m 2 basis). Docetaxel was not mutagenic in the Ames test or the CHO/HGPRT gene mutation assays.
Docetaxel did not reduce fertility in rats when administered in multiple intravenous doses of up to 0.3 mg/kg (about 1/50 th the recommended human dose on a mg/m 2 basis), but decreased testicular weights were reported. This correlates with findings of a 10-cycle toxicity study (dosing once every 21 days for 6 months) in rats and dogs in which testicular atrophy or degeneration was observed at intravenous doses of 5 mg/kg in rats and 0.375 mg/kg in dogs (about 1/3 rd and 1/15 th the recommended human dose on a mg/m 2 basis, respectively).
An increased frequency of dosing in rats produced similar effects at lower dose levels.
📄 Carcinogenesis, Mutagenesis, Impairment of Fertility ▾
13.1Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenicity studies with docetaxel have not been performed. Docetaxel was genotoxic by an aneugenic mechanism in the in vitro chromosome aberration test in CHO-K 1 cells and in the in vivo micronucleus test in mice administered doses of 0.39 to 1.56 mg/kg (about 1/60 th to 1/15 th the recommended human dose on a mg/m 2 basis). Docetaxel was not mutagenic in the Ames test or the CHO/HGPRT gene mutation assays.
Docetaxel did not reduce fertility in rats when administered in multiple intravenous doses of up to 0.3 mg/kg (about 1/50 th the recommended human dose on a mg/m 2 basis), but decreased testicular weights were reported. This correlates with findings of a 10-cycle toxicity study (dosing once every 21 days for 6 months) in rats and dogs in which testicular atrophy or degeneration was observed at intravenous doses of 5 mg/kg in rats and 0.375 mg/kg in dogs (about 1/3 rd and 1/15 th the recommended human dose on a mg/m 2 basis, respectively).
An increased frequency of dosing in rats produced similar effects at lower dose levels.
📚 References ▾
15 REFERENCES 1. "OSHA Hazardous Drugs." http://www.osha.gov/SLTC/hazardousdrugs/index.html
📄 Package Label / Principal Display Panel ▾
PACKAGE LABEL.PRINCIPAL DISPLAY PANEL BEIZRAY (docetaxel) Injection 80 mg/4 mL (20 mg/mL) For Intravenous Infusion Only Must be diluted before use in a prepared Albumin (Human) in 0.9% Sodium Chloride Injection solution Do not substitute BEIZRAY for other docetaxel products Discard unused portion Warning: Hazardous Drug BEIZRAY (docetaxel) Injection, 80 mg/4 mL -Vial Label BEIZRAY (docetaxel) Injection, 80 mg Kit -Carton Label Each kit Contains: -One 4 mL Single-dose vials of Beizray (docetaxel) Injection -One 50 mL Single-dose vial of IV Solution Stabilizer (Human Albumin 25%) BEIZRAY (docetaxel) Injection, 160 mg Kit -Carton Label Each kit Contains: -Two 4 mL Single-dose vials of Beizray (docetaxel) Injection -One 50 mL Single-dose vial of IV Solution Stabilizer (Human Albumin 25%) BEIZRAY (docetaxel) Injection, 80 mg single-dose vial -Carton Label Contains One 4 mL Single-dose vial of Beizray (docetaxel) Injection only BEIZRAY (docetaxel) Injection 20 mg/mL For Intravenous Infusion Only Must be diluted before use in a prepared Albumin (Human) in 0.9% Sodium Chloride Injection solution Do not substitute BEIZRAY for other docetaxel products Discard unused portion Warning: Hazardous Drug BEIZRAY (docetaxel) Injection, 20 mg/mL -Vial Label BEIZRAY (docetaxel) Injection, 20 mg single-dose vial -Carton Label Contains One 1 mL Single-dose vial of Beizray (docetaxel) Injection only vial 80 mg kit 160 mg kit 80 mg carton 20 mg/mL vial label 20 mg/mL carton label
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