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Capecitabine ("Xeloda")

	What is capecitabine and how does it work? Capecitabine is a relatively new chemotherapy drug which is taken in tablet form because it is well absorbed from the stomach (unlike most chemotherapy drugs which have to be given directly into the blood stream). It is inactive itself, but is converted in the liver and in tumour tissue into the active anti-cancer drug, 5-fluorouracil (5-FU). 5-FU belongs to a class of anticancer drugs called antimetabolites. These drugs form “false building blocks” in molecules inside cancer cells, like DNA, “tricking” the cell into incorporating them and leading to a consequent breakdown of cellular machinery and tumour cell death. Because capecitabine is principally activated within tumours, it has relatively few effects on normal tissues, and therefore relatively few side-effects. Although the drug is partially activated in the liver, there is no evidence that the presence of secondary tumours (“metastases”) in the liver interferes with this activation or with the efficacy of the drug. Tumours that have previously failed to respond to 5-fluorouracil itself may still respond to capecitabine and the reasons for this are still being worked out. The bottom line, though, is that capecitabine is a good choice for treatment of breast cancer that may have progressed after initial treatment with a variety of chemotherapy drugs including “AC” and “CMF”. Capecitabine is given in tablet form, usually as 500 mg tablets, in a dose of between 2 and 6 tablets twice daily for two weeks, followed by one week’s rest. Capecitabine tablets should be taken with or immediately after food. It is essential that you take the tablets exactly as instructed by your oncologist, keeping a diary each day, and carefully observing the rest week. DO NOT take capecitabine continuously, without a rest week, as serious life-threatening side-effects may occur. Capecitabine is usually given as a single agent, but there are new protocols under development in which it is used in combination with other chemotherapy drugs, like docetaxel (“Taxotere”). Capecitabine is available on the Pharmaceutical Benefits Scheme (PBS (Australia) for the treatment of metastatic breast cancer after failure of an anthracycline (like Adriamycin) or a taxane (like Taxol or Taxotere). Capecitabine is also available for the treatment of metastatic bowel cancer. Side-effects of capecitabine General. Patients receiving therapy with Capecitabine must be carefully monitored by an experienced oncologist and associated chemotherapy nursing staff. Most adverse reactions are reversible and do not need to result in discontinuation, although doses may need to be withheld or reduced. Do not be alarmed if your dose schedule requires fairly constant changing – this is common and usually does not affect efficacy. Diarrhoea. Capecitabine can induce mild to severe diarrhoea. If the capecitabine is being used as a single agent, the diarrhoea may not come on until shortly after the second cycle of treatment has begun, but occasionally more severe and abrupt diarrhoea may occur. Notes on management of diarrhoea may be found HERE . If any of these features are present you should cease the medication and seek medical advice: More than 4-6 bowel motions per day Bowel motions occurring during normal sleeping hours Presence of blood or mucus in the motion Associated cramping abdominal pain Associated nausea and vomiting Associated severe mouth soreness and/or ulceration Dehydration In milder cases CLICK HERE .“Hand-foot” syndrome. This is a common side-effect of capecitabine – around 1 in 3 women get it. Its full medical name, for those of you who like such things, is palmar plantar erythrodysaesthesia! It comes on usually after 2 or 3 cycles of treatment. It is characterised by the following: grade 1 is defined by numbness, slight pain or “pins and needles”, tingling or rednessof the palms and/or soles and/or discomfort which does not disrupt normal activity. Grade 2 hand foot syndrome is defined as painful redness and swelling of the hands and/or feet that results in discomfort affecting the patient's activities of daily living and grade 3 hand foot syndrome is defined as moist peeling of the skin of the hands and feet, ulceration, blistering and severe pain of the hands and/or feet that results in severe discomfort that causes the patient to be unable to work or perform activities of daily living. If grade 2 or 3 hand foot syndrome occurs, administration of capecitabine should be ceased until the event resolves or reduces in intensity to grade 1. Following grade 3 hand foot syndrome, subsequent doses of capecitabine should be decreased (see Dosage and Administration). Care of Hands and Feet: There is no definite way of preventing this problem, but it is prudent to take good care of your hands and feet as follows: Wear loose, comfortable, covered shoes, to avoid trauma to the feet and toes Elevate the feet in the evenings, and whenever possible during the day. Use a warm saline footbath each evening (1 tablespoon of table salt in 4 pints of water) – soak for 10-15 minutes, pat dry and keep warm. Wear rubber gloves for all household chores Use a moisturising hand lotion after washing your hands Vitamin B6. Some claim that this helps the hand-foot syndrome but I have seen no evidence for it and do not usually recommend it. Mouth Soreness (“Stomatitis”) and “Mucositis” CLICK HERE Cardiac side-effects Very rarely, capecitabine my exacerbate coronary artery disease, causing angina, or occasionally myocardial infarction or irregular heart rhythms. It is important that your doctor is aware of any previous history of heart disease. Nausea and Vomiting. This is relatively rare with capecitabine. Tips may be found at CLICK HERE . Anorexia. Loss of appetite is a relatively common problem while taking capecitabine. Low white blood cells and infection If you take Xeloda strictly as directed this should not be a problem, but you need to have your blood count regularly checked. See extra notes on this HERE Fatigue Fatigue and poor energy levels anr also common in people taking Xeloda. Special Precautions Drug interactions may occur with the blood-thinning agent warfarin and with the anti-epileptic drug Dilantin. What patient’s say: Pauline: “I found Xeloda amazing. Compared to some of the other chemotherapy drugs I had taken previously, the side-effects were minimal, and there was the added convenience of being able to take it in tablet form. I still had to attend the chemotherapy suite every three weeks and get a blood count, but that was no big deal. It was fantastic not to lose my hair this time round! I did get sore, red palms and soles during the third cycle of treatment but this responded very quickly to a dose reduction. I have had a total of 7 cycles of treatment and my disease is in complete remission! Bob and I had a bottle of French Champagne the night we got that news!" (Names and identities changed to preserve privacy.) 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