Capecitabine: an overview of the side effects and their management.
ABSTRACT Xeloda (capecitabine), a thymidine phosphorylase activated fluoropyrimidine carbamate, is currently the only universally approved orally administered 5-fluorouracil (5-FU) prodrug. It belongs to a newer generation of orally administered fluoropyrimidines. It has been developed because of the clinical need for efficient, tolerable and convenient agents, which do not require continuous infusion. Capecitabine is not a cytotoxic drug in itself, but via a three-step enzymatic cascade, it is converted to 5-FU mainly within human cancer cells. While the drug compares favorably with 5-FU in patients with advanced or metastatic colorectal cancer and pretreated breast cancer, it also has an improved toxicity profile, mainly of gastrointestinal and dermatologic effects with a significantly lower incidence of grade 3/4 myelotoxicity compared with infusional 5-FU-based chemotherapy. Capecitabine's selective activation within the tumor allows for less systemic toxicity events. A gradient of fluoropyrimidine toxicity is observed: high in the US and low in East Asia. In addition, there is a discrepancy in tolerance of dose among patients treated in the US vs. Europe. Although patients can take the drug orally in the convenience of their own home, the key to successful management of capecitabine is the clinician's awareness of its severe, but low in incidence, adverse effects, and the patients' education, emphasizing compliance with the treatment plan, prevention and timely recognition of its toxicities.
Article: Hand-Foot Syndrome Accompanied by Severe Oral Lesions during Capecitabine Therapy for Metastatic Colon Carcinoma[show abstract] [hide abstract]
ABSTRACT: Hand-foot syndrome (HFS) is a side effect of some chemotherapeutics appearing as dysesthesia, sharp-edged plaques and symmetrical lesions on palmoplantar areas. Our case is a 68-year-old male patient who developed a slight erythema and desquamation on the palms and soles of the feet during the third cycle of capecitabine treatment for advanced metastatic carcinoma. With this case report we aimed to draw attention to the development of HFS in patients receiving chemotherapy with capecitabine and raise awareness in the issue. The nonexistance of data in contemporary literature about the occurrence of hemorrhagic bullae in the oral mucosa makes our case noteworthy. (Marmara Medical Journal 2011;24:200-2) Key Words: Chemotherapy-induced, Palmoplantar erythema, Side effect, Chemotherapeutics, Drug-induced reaction, CapecitabineMarmara Medical Journal 01/2011;
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ABSTRACT: Capecitabine is currently the only novel, orally home-administered fluorouracil prodrug. It offers patients more freedom from hospital visits and less inconvenience and complications associated with infusion devices. The drug has been extensively studied in large clinical trials in many solid tumors, including breast cancer, colorectal cancer, gastric cancer, and many others. Furthermore, the drug compares favorably with fluorouracil in patients with such cancers, with a safe toxicity profile, consisting mainly of gastrointestinal and dermatologic adverse effects. Whereas gastrointestinal events and hand-foot syndrome occur often with capecitabine, the tolerability profile is comparatively favorable. Prompt recognition of severe adverse effects is the key to successful management of capecitabine. Ongoing and future clinical trials will continue to examine, and likely expand, the role of capecitabine as a single agent and/or in combination with other anticancer agents for the treatment of gastrointestinal as well as other solid tumors, both in the advanced palliative and adjuvant settings. The author summarizes the current data on the role of capecitabine in the management of gastrointestinal cancers.OncoTargets and Therapy 01/2009; 2:29-41. · 1.26 Impact Factor