By Wendy Pritchett, MSN, RN, OCN®, and Karen Kinsley, BSN, RN, OCN®
Capecitabine (Xeloda®) was approved by the U.S. Food and Drug Administration (FDA) in 1998 as a nucleoside metabolic inhibitor with antineoplastic activity indicated for adjuvant colon cancer, metastatic colorectal cancer, and metastatic breast cancer.
- Adjuvant treatment of Dukes’ C colon cancer in adults who have undergone complete resection of the primary tumor as monotherapy when treatment with fluoropyrimidine therapy alone is preferred
- First-line treatment of metastatic colorectal cancer in adults as monotherapy, when fluoropyrimidine therapy alone is preferred
- Metastatic breast cancer in adults in combination with docetaxel after failure of prior anthracycline-containing therapy
- Metastatic breast cancer as a monotherapy in adults resistant to both paclitaxel and an anthracycline-containing regimen
1,250 mg/m2 administered twice daily as a monotherapy or in combination with another infusional chemotherapy regimen, 14 days on and 7 days off in a three-week cycle
Orally with water within 30 minutes after a meal
A black box warning is included on FDA labeling: “Altered coagulation or bleeding, including death, has been reported in patients using capecitabine and oral coumarin-derivative anticoagulants. This occurs within several days to several months after starting capecitabine; may also occur within one month of stopping capecitabine.”
The most common side effects (> 30%) are diarrhea, hand and foot syndrome, mucositis, nausea, vomiting, abdominal pain, hyperbilirubinemia and fatigue. Potential severe side effects are neutropenia, anemia, thrombocytopenia, myocardial ischemia, renal failure, embryofetal toxicity, dermatologic toxicities, and hyperbilirubinemia. No dose has been proven to be safe in patients with low or absent diphydropyrimidine dehydrogenase activity. Grade 2 or higher toxicities may require dose reductions or interruptions; see package insert for full information.
Consider prophylactic antidiarrheal medications and instruct patients to notify the provider if diarrhea occurs. Monitor patients’ hepatic, hematologic, and renal laboratory values. Ensure women of childbearing age have a pregnancy test prior to initiating therapy. Educate patients and caregivers about the hazardous drug safe handling recommendations, including body fluids and waste.
Drug-Drug and Drug-Food Interactions
Capecitabine can increase the plasma concentrations of several medications. Refer to the package insert for full details. Food can reduce the rate and extent of absorption.
- Administer with water within 30 minutes of a meal.
- Do not crush the medication or mix it with other medications in pill boxes.
- Do not take two doses at the same time or extra doses. Call your provider if you miss a dose.
- Use emollients on your hands and feet and report any skin changes.
- Do not breastfeed while on treatment.
- Use effective contraception for six months after the last dose.
Older patients have a greater incidence of adverse reactions and should be closely monitored.
Capecitabine is a hazardous drug; patients and caregivers should use safe handling procedures and contact their local municipalities or drug take-back programs for medication disposal.
Patient Assistance Programs
A financial assistance program is available online.