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Capecitabine

Capecitabine (brand name: Xeloda®) is an orally-administered chemotherapeutic agent used in the treatment of metastatic breast and colorectal cancers. It is enzymatically converted to fluorouracil in the body, where it inhibits DNA synthesis and slows growth of tumor tissue. more...

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Indications

Capecitabine is FDA-approved for:

Metastatic Colorectal Cancer

  • Used as first-line monotherapy, if appropriate.

Metastatic Breast Cancer

  • Used in combination with docetaxel, after failure of anthracycline-based treatment.
  • Used as monotherapy, if the patient has failed paclitaxel-based treatment, and if anthracycline-based treatment has either failed or cannot be continued for other reasons (i.e., the patient has already received the maximum lifetime dose of an anthracycline).

Dose

The usual starting dose is 2,500 mg/m2/day in two divided doses, 12 hours apart. One cycle includes two weeks of treatment followed by one week without treatment. Cycles can be repeated every three weeks.

Dose Adjustments

  • For mild renal dysfunction (creatinine clearance 30-50 mL/min), it is recommended to reduce dose by 25%.
  • For severe renal dysfunction (creatinine clearance <30 mL/min), treatment is not recommended.
  • There is no recommendation for hepatic dysfunction.
  • For elderly patients, lower doses may be required due to higher incidences of serious adverse reactions.

Administration

Take orally with water, within 30 minutes after a meal.

Potential Adverse Reactions (Major)

  • Cardiovascular: EKG changes, myocardial infarction, angina (these may be more common in patients with pre-existing coronary artery disease)
  • Dermatological: Hand-foot syndrome (numbness, tingling, pain, redness, or blistering of the palms of the hands and soles of the feet)
  • Gastrointestinal: Diarrhea (sometimes severe), nausea, stomatitis
  • Hematological: Neutropenia, anemia, thrombocytopenia
  • Hepatic: Hyperbilirubinemia

Drug Interactions

  • Capecitabine may interact with warfarin and increase bleeding risk. It is recommended to watch coagulation levels (INR) closely and adjust warfarin doses appropriately.
  • Capecitabine may inhibit cytochrome CYP2C9 enzyme, and therefore increase levels of substrates such as phenytoin. It is recommended to monitor phenytoin levels in patients taking both medications. Other substrates of CYP2C9 may also be affected. Evaluate according to clinical judgment.
  • Much as fluorouracil, the concomitant use of leucovorin may increase both the efficacy and the toxicity of capecitabine.

Pregnancy / Lactation Information

  • Capecitabine is pregnancy category D. Women of childbearing potential are advised to avoid becoming pregnant while using capecitabine.
  • Significant amounts of capecitabine may be excreted into the breast milk. It is recommended to discontinue nursing while using capecitabine.

Read more at Wikipedia.org


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Capecitabine
From Gale Encyclopedia of Cancer, by Ph.D. Margaret Alic

Definition

Capecitabine (brand name Xeloda) is a drug that interferes with the growth of cancer cells.

Purpose

Capecitabine is used to treat breast cancer and cancer of the colon and rectum (colorectal cancer) that have spread to other parts of the body (metastasized).

Description

Capecitabine is a recently developed drug. It is a type of medicine called an antimetabolite because it interferes with the metabolism and growth of cells. Capecitabine is an unusual anti-cancer drug in that it is most active in cancer cells; normal cells are exposed to far lower concentrations of the drug. Cancer cells convert capecitabine into another anti-cancer drug called 5-fluorouracil (fluorouracil). This substance prevents cells from growing and reproducing by interfering with the production of DNA and RNA. Eventually the cells die.

Capecitabine has been approved by the U.S. Food and Drug Administration for the treatment of metastasized breast cancer that is resistant to standard chemotherapy. Capecitabine may be used in combination with the drug docetaxel (Taxotere). A study completed in 2000 found that 56% of women receiving this combination therapy survived at least one year, with an average survival time of 14 months.

A study completed in 2001 found that capecitabine is as effective as 5-fluorouracil for treating metastasized colorectal cancer, and has fewer and less severe side effects. However, it does not increase the average survival time of approximately 13 months.

Recommended dosage

The dosage of capecitabine depends on a number of factors including body size. The average dosage is 2500 mg per square meter of body surface area per day. Capecitabine is a pill that is taken with water within 30 minutes after a meal. It may be taken every 12 or 24 hours. For colorectal cancer, capecitabine may be administered for two weeks, followed by one week off, for a total of 30 weeks.

Precautions

Capecitabine can temporarily reduce the number of white blood cells, thus reducing the body's ability to fight infection. Thus, it is very important to avoid exposure to infections and to receive prompt medical treatment. Immunizations (vaccinations) should be avoided during or after treatment with capecitabine. It also is important to avoid contact with individuals who have recently taken an oral polio vaccine.

Capecitabine may temporarily reduce the number of blood platelets that are necessary for blood clotting. The risk of bleeding may be reduced by:

  • using caution when cleaning teeth

  • avoiding dental work

  • avoiding cuts, bruises, or other injuries

Capecitabine can cause birth defects and fetal death in animals. Therefore this drug should not be taken by pregnant women or by either the man or the woman at the time of conception. Because capecitabine may cause serious side effects, women usually are advised against breast-feeding while taking this drug.

Some individuals may have an allergic reaction to capecitabine. Allergies to foods, preservatives, or dyes, or to the drug 5-fluorouracil must be considered before this drug is prescribed.

Side effects

Common side effects of capecitabine may include:

  • loss of appetite (anorexia

  • diarrhea

  • nausea and vomiting

  • stomach or abdominal pain

  • swelling, peeling, redness, or blistering of hands and feet

  • numbness, pain, itching, or tingling in hands and feet

  • pain, swelling, or sores in the mouth or on the lips

  • rashes or dry skin

  • fatigue or weakness due to reduced red blood cell count

The treatment is stopped if side effects are severe enough to interfere with eating or other normal activities.

Less common or rare side effects of capecitabine may include:

  • constipation

  • cough or hoarseness

  • difficulty swallowing

  • shortness of breath

  • chest pain

  • blood pressure changes

  • fast or irregular heartbeat

  • pain or swelling of the ankles, legs, or stomach

  • poor coordination, dizziness

  • changes in fingernails or toenails

  • headache

  • heartburn

  • sensitivity to sunlight

  • muscle pain

  • eye irritation

  • insomnia

  • lower back or side pain

  • painful or difficult urination

Side effects of capecitabine may include symptoms of infection, such as fever, chills, sore throat, or swollen glands, or symptoms of liver malfunction. Side effects also may include unusual bleeding or bruising due to the reduction in blood platelets.

Other diseases or medical conditions may increase the side effects associated with capecitabine. Chicken pox or shingles (Herpes zoster) may become very severe and spread to other parts of the body. If heart, kidney, or liver disease is present, the side effects related to these organs may be more severe. In addition, in the presence of liver disease, the amount of capecitabine in the body may be higher. Individuals over the age of 80 often experience more severe side effects with capecitabine.

Interactions

Other drugs that may interact with capecitabine include:

  • Amphotericin B (Fungizone)

  • Antithyroid drugs that are used to treat an overactive thyroid

  • Azathioprine (Imuran)

  • Chloramphenicol (Chloromycetin)

  • Colchicine

  • Flucytosine (Ancobon)

  • Ganciclovir (Cytovene)

  • Interferon (Intron A, Roferon-A)

  • Plicamycin (Mithracin)

  • Zidovudine (AZT, Retrovir)

Coumarin-type anticoagulants that are used to thin the blood and medicines containing aspirin can increase the chances of bleeding. Folic acid, alone or in a multi-vitamin, may increase the side effects of capecitabine. Finally, capecitabine can increase the effects on the blood of other cancer medicines or radiation therapy.

KEY TERMS

Colorectal cancer
Cancer of the colon and rectum.

Metastasis
Spread of cancer from its point of origin to other parts of the body.

Platelet
Blood component that aids in clotting.

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