Stage IV NSCLC: near-complete response despite severe docetaxel-induced diarrhea

What happened, in summary

This 72-year-old man was diagnosed with Stage IV non-small-cell lung cancer in March 2012. He began weekly docetaxel-cisplatin chemotherapy, using docetaxel 35 mg/m2 and cisplatin 30 mg/m2 on days 1 and 8 of each 3-week cycle. The first cycle was difficult: by day 3, he developed grade 3 nausea and vomiting, requiring fasting, parenteral nutritional support, hydration, metoclopramide, and lorazepam. During the second cycle, nausea did not recur, but severe watery diarrhea developed from day 4. He was admitted on day 6 with grade 3 diarrhea and dehydration. There was no abdominal pain, fever, blood, pus, pathogen, or inflammatory marker elevation, making infection unlikely. Treatment included fasting, parenteral nutrition, hydration, and loperamide. The diarrhea improved, recurred when eating restarted, and then improved again. His day 8 chemotherapy dose was delayed to day 16 and reduced by 20%, but severe diarrhea returned after treatment. His doctors concluded the diarrhea was docetaxel-induced. CT after 2 cycles showed a near-complete response, so chemotherapy continued with careful prevention rather than stopping a regimen that was working. From cycle 3 onward, he received the reduced dose with prophylactic loperamide and planned fasting around treatment. The fasting period and loperamide schedule were gradually shortened when tolerated, and later cycles were completed without recurrent diarrhea. This made it possible to balance tumor control with side-effect management. The treatment course was notable because severe toxicity did not prevent continuation once the diarrhea-prevention plan was adjusted around each infusion. As of October 2013, he had completed 6 cycles of docetaxel-cisplatin and achieved a near-complete response.