Xeloda


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capecitabine

Xeloda

Pharmacologic class: Fluoropyrimidine, antimetabolite (pyrimidine analog)

Therapeutic class: Antineoplastic

Pregnancy risk category D

FDA Box Warning

• In patients receiving concomitant oral coumarin-derivative anticoagulants (such as warfarin and phenprocoumon), monitor International Normalized Ratio (INR) or prothrombin time (PT) frequently to allow appropriate anticoagulant dosage adjustment. Altered coagulation parameters, bleeding, and death have occurred in patients taking this drug combination. Postmarketing reports show significant INR and PT increases in patients stabilized on anticoagulants when capecitabine therapy began. Age older than 60 and cancer diagnosis independently increase coagulopathy risk.

Action

Enzymatically converts to 5-fluorouracil, which injures cells by interfering with DNA synthesis, cell division, RNA processing, and protein synthesis

Availability

Tablets: 150 mg, 500 mg

Indications and dosages

Metastatic breast cancer resistant to both paclitaxel and a chemotherapy regimen that includes anthracycline; metastatic colorectal cancer when treatment with fluoropyrimidine therapy alone is preferred

Adults: Initially, 2,500 mg/m2/day P.O. in two divided doses for 2 weeks, followed by a 1-week rest period; administered in 3-week cycles

Dosage adjustment

• Renal impairment
• Hepatic impairment
• Elderly patients

Contraindications

• Hypersensitivity to drug
• Severe renal impairment
• Pregnancy or breastfeeding

Precautions

Use cautiously in:
• mild to moderate renal impairment, hepatic impairment, severe diarrhea, coronary artery disease, intestinal disease, infection, coagulopathy
• children younger than age 18.

Administration

• Give with water within 30 minutes after a meal.
• If dosage must be lowered because of toxicity, don't increase dosage later.

Adverse reactions

CNS: dizziness, fatigue, headache, insomnia, paresthesia

CV: edema

EENT: eye irritation

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, anorexia, stomatitis, intestinal obstruction

Hematologic: anemia, lymphopenia, neutropenia, thrombocytopenia

Metabolic: dehydration

Musculoskeletal: myalgia, limb pain

Skin: dermatitis, alopecia, nail disorder, hand and foot syndrome (palmarplantar erythrodysesthesia)

Other: fever

Interactions

Drug-drug.Antacids: increased capecitabine blood level

Leucovorin: increased cytotoxicity

Live-virus vaccines: impaired ability to mount an immune response to vaccine

Phenytoin: increased phenytoin blood level

Warfarin: increased risk of bleeding

Drug-diagnostic tests.Bilirubin: increased level

Hemoglobin, neutrophils, platelets, white blood cells: decreased levels

Patient monitoring

• Monitor patient for signs and symptoms of toxicity. Be prepared to reduce dosage or withhold drug when indicated.
• Stay alert for signs and symptoms of infection.
• Carefully assess fluid and electrolyte status if patient has severe diarrhea.
• Monitor weight, CBC, International Normalized Ratio, prothrombin time, and kidney and liver function test results.
• Evaluate closely for adverse reactions in patients older than age 80.

Patient teaching

• Advise patient to take drug with water within 30 minutes after a meal.

Instruct patient to immediately report nausea, vomiting, diarrhea, mouth ulcers, swollen joints, temperature above 100.5 °F (38 °C), and other signs or symptoms of infection.
• Tell patient to expect dosage adjustments during therapy.
• Urge patient to use reliable birth control method because drug may harm fetus if she becomes pregnant.
• Caution patient not to breastfeed during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

Xeloda

(zĕ-lō′də)
A trademark for the drug capecitabine.

capcytobine

A prodrug of the chemotherapeutic 5-fluorouracil (5-FU), which is used to treat metastatic breast and colorectal cancers. 5-FU inhibits DNA synthesis and slows tumour proliferation.

Adverse effects
EKG changes, acute myocardial infarction, angina, hand-foot syndrome, pain, paraesthesia, erythema, palmoplantar blistering, diarrhoea, nausea, stomatitis, pancytopaenia, hyperbilirubinaemia.

Xeloda®

Capecitabine Oncology An anticancer agent used for therapy-resistant metastatic breast CA, which targets and is activated by tumor cell enzymes; once activated, the drug is converted to 5-FU. See Breast cancer, 5-FU.
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References in periodicals archive ?
The trial has enrolled approximately 600 patients who are randomized to receive either PB272 plus Xeloda or Tykerb plus Xeloda.
With the approval of the combination therapy of Xeloda and oxaliplatin showing preventive efficacy for postoperative recurrence, we hope the patients will receive the anti-cancer treatment in a positive frame of mind.
People receiving Kadcyla experienced a 32 percent reduction in the risk of dying compared to people who received lapatinib and Xeloda (HR=0.
The National Institute for Health and Clinical Excellence (NICE) have today issued its final draft of guidance, advising against NHS funding for oral Tyverb - also known as lapatinib - in combination with the oral chemotherapy drug Xeloda.
In a second piece of draft guidance, Nice approved Xeloda (capecitabine) for advanced stomach cancer, which affects around 8,200 people each year in the UK.
Although Xeloda works well against breast cancer that has spread, it does not appear to prevent spread in women with early-stage breast cancer.
The FDA has approved Tykerb (lapatinib), in combination with Xeloda (capecitabine), for the treatment of women with advanced HER2-positive breast cancer who have received prior therapy.
He reports that GlaxoSmithKline, the manufacturer of the new drug, named it "Tykerb" and it is to be taken together with Herceptin or Xeloda.
FDA Approves XELODA, First Oral Chemotherapy for the Treatment of Metastatic Colorectal Cancer.
En el Congreso Mundial de la Sociedad Americana de Oncologia Clinica (ASCO), celebrado el 5 de junio en Atlanta, Estados Unidos, investigadores mexicanos presentaron datos de impacto positivo en la supervivencia y la calidad de vida de los pacientes con cancer de mama metastatico (diseminado a otros organos) que recibieron una nueva combinacion de farmacos: Xeloda (Capecitabine) con cualquier taxano (quimioterapia).
Two chemotherapy treatments - one a combination of drugs including Eloxatin and the other an oral tablet known as Xeloda - are thought to offer a potential cure for patients who are caught soon enough.