Xeloda (capecitabine) is an orally administered prodrug chemotherapy agent specifically designed to deliver targeted 5-fluorouracil (5-FU) therapy directly to tumor cells. As a fluoropyrimidine carbamate, it offers a convenient and effective treatment option for patients with specific gastrointestinal and breast malignancies. Its unique mechanism allows for selective activation within tumor tissue, potentially maximizing efficacy while offering a favorable administration profile compared to traditional intravenous regimens. This targeted approach represents a significant advancement in convenience and precision for appropriate oncology patients.

Features

• Orally administered prodrug of 5-fluorouracil (5-FU)
• Selective activation to 5-FU primarily within tumor tissues via thymidine phosphorylase
• Available in 150 mg and 500 mg film-coated tablets
• Typically administered in 3-week cycles (2 weeks treatment, 1 week rest)
• Requires conversion through a three-step enzymatic process in the body
• Compatible with various combination chemotherapy regimens

Benefits

• Provides targeted delivery of chemotherapy directly to tumor sites, potentially enhancing efficacy while minimizing systemic exposure
• Offers convenient oral administration, eliminating the need for intravenous infusions and associated clinic visits
• Enables flexible dosing schedules that can be managed in the outpatient setting
• Demonstrates proven efficacy in both metastatic settings and adjuvant treatment of appropriate cancers
• Allows for potential dose modifications based on individual patient tolerance and response
• Provides a therapeutic option for patients who may not be candidates for continuous infusion 5-FU

Common use

Xeloda is indicated for the treatment of patients with metastatic colorectal cancer, either as monotherapy or in combination with other chemotherapeutic agents. It is also approved for adjuvant treatment of patients with Dukes’ C colon cancer who have undergone complete resection of the primary tumor. Additionally, Xeloda is indicated for the treatment of patients with metastatic breast cancer that is resistant to both paclitaxel and an anthracycline-containing chemotherapy regimen, or resistant to paclitaxel and for whom further anthracycline therapy is not indicated. It may be used as first-line treatment for metastatic breast cancer when combination chemotherapy with capecitabine and docetaxel is indicated.

Dosage and direction

The recommended dosage of Xeloda is 1250 mg/m² administered orally twice daily (morning and evening, approximately 12 hours apart) for 2 weeks followed by a 1-week rest period, given as 3-week cycles. Tablets should be swallowed whole with water within 30 minutes after a meal. Dosage adjustments are recommended based on body surface area and should be individualized according to patient tolerance and treatment response. For patients with moderate renal impairment (creatinine clearance 30-50 mL/min), the recommended starting dose is 75% of the standard dose. Treatment should continue until disease progression or unacceptable toxicity occurs.

Precautions

Patients should be closely monitored for diarrhea, as severe diarrhea may require dose interruption or reduction. Hand-foot syndrome (palmar-plantar erythrodysesthesia) may occur and can be managed with dose modifications and supportive care. Regular monitoring of complete blood counts is essential to detect myelosuppression. Patients with dihydropyrimidine dehydrogenase (DPD) deficiency may experience severe, life-threatening toxicity and should be identified before treatment initiation. Cardiac monitoring is recommended, as cardiotoxicity including myocardial infarction, angina, dysrhythmias, and cardiac arrest have been reported. Hepatic function should be monitored regularly in patients with pre-existing liver impairment.

Contraindications

Xeloda is contraindicated in patients with known hypersensitivity to capecitabine or any component of the formulation. It is contraindicated in patients with known complete absence of dihydropyrimidine dehydrogenase (DPD) activity. The combination of Xeloda with sorivudine or its chemically related analogues such as brivudine is contraindicated due to the risk of severe and potentially fatal toxicity. Xeloda is contraindicated in patients with severe renal impairment (creatinine clearance below 30 mL/min). Pregnancy and breastfeeding are absolute contraindications due to the potential for fetal harm and secretion in human milk.

Possible side effect

Common adverse reactions include diarrhea (which may be severe), hand-foot syndrome, nausea, vomiting, stomatitis, fatigue, anorexia, and abdominal pain. Hematological toxicities may include neutropenia, thrombocytopenia, and anemia. Dermatological effects may include dermatitis, rash, dry skin, and nail disorders. Other potential side effects include hyperbilirubinemia, increased liver enzymes, fever, edema, headache, dizziness, insomnia, and peripheral sensory neuropathy. Serious adverse reactions may include severe diarrhea requiring hospitalization, cardiotoxicity, severe hand-foot syndrome requiring dose modification, and severe myelosuppression.

Drug interaction

Xeloda may interact with warfarin, requiring frequent monitoring of INR and prothrombin time as coagulopathy and bleeding have been reported. Concomitant administration with phenytoin may increase phenytoin levels, necessitating close monitoring. Drugs that induce or inhibit cytochrome P450 enzymes may affect Xeloda metabolism. Antacids may alter the absorption of capecitabine. Combination with other myelosuppressive drugs may exacerbate hematological toxicity. Live vaccines should be avoided during treatment due to the potential for increased risk of infection.

Missed dose

If a dose is missed, the patient should not take the missed dose at the next scheduled time. Instead, they should continue with the next prescribed dose at the regularly scheduled time. Patients should not double the dose to make up for a missed dose. Healthcare providers should be informed about any missed doses, as this may affect treatment efficacy and toxicity profile. A medication diary or pill organizer is recommended to help maintain the prescribed dosing schedule.

Overdose

Overdose of Xeloda may lead to severe gastrointestinal toxicity (nausea, vomiting, diarrhea, gastrointestinal irritation and bleeding), bone marrow suppression, and acute renal failure. Management of overdose should include immediate discontinuation of the drug and initiation of supportive care. Hematological parameters should be monitored closely, and appropriate supportive measures including blood product transfusions may be necessary. Hemodialysis has not been studied as a treatment for capecitabine overdose but may be considered based on the drug’s pharmacokinetic properties. There is no specific antidote for capecitabine overdose.

Storage

Xeloda tablets should be stored at room temperature between 15°C and 30°C (59°F and 86°F) in their original container. The medication should be protected from moisture and light. Tablets should be kept out of reach of children and pets. Unused medication should be disposed of properly according to local regulations for chemotherapy drugs. Patients should not store Xeloda in bathroom cabinets or other areas with high humidity. The blister packs should remain sealed until immediately before use.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Xeloda should only be used under the supervision of a qualified healthcare professional experienced in cancer chemotherapy. Treatment decisions should be based on individual patient characteristics, including disease stage, overall health status, and potential risk factors. The prescribing information provided by the manufacturer should be consulted for complete details regarding administration, contraindications, and warnings. Patients should discuss all potential risks and benefits with their oncologist before initiating treatment.

Reviews

Clinical studies have demonstrated Xeloda’s efficacy in multiple cancer types, with response rates comparable to intravenous 5-FU in metastatic colorectal cancer. In breast cancer trials, combination therapy with docetaxel showed superior response rates compared to docetaxel alone. Many oncologists appreciate the oral administration route for patient convenience and quality of life improvements. However, healthcare providers note the importance of careful patient education regarding side effect management, particularly for hand-foot syndrome and diarrhea. Patient-reported outcomes often highlight the convenience of home-based administration while acknowledging the challenge of managing treatment-related side effects.