Xeloda (capecitabine) is an orally administered prodrug chemotherapy agent specifically designed for the treatment of certain solid tumors. It belongs to the class of fluoropyrimidine carbamates and is converted into its active form, 5-fluorouracil (5-FU), directly within tumor tissue. This targeted activation mechanism allows for higher concentrations of the cytotoxic agent at the tumor site while potentially minimizing systemic exposure. It is a cornerstone treatment in oncology, offering a convenient oral alternative to continuous intravenous infusions.

Features

• Active pharmaceutical ingredient: Capecitabine
• Available in film-coated tablet strengths of 150 mg and 500 mg
• Oral administration, eliminating the need for intravenous access or infusion pumps
• Prodrug activation occurs preferentially in tumor tissue via the enzyme thymidine phosphorylase
• Mimics continuous infusion of 5-fluorouracil (5- FU) through its pharmacokinetic profile
• Typically administered in 3-week cycles (2 weeks on, 1 week off)

Benefits

• Provides the efficacy of continuous 5-FU infusion without requiring a central venous line or prolonged hospital stays
• Enables treatment from home, improving quality of life and allowing for greater normalcy during therapy
• Targeted activation within tumors may enhance antitumor activity while potentially reducing some systemic side effects
• Flexible dosing allows for individual adjustment based on tolerance and specific clinical scenarios
• Well-established efficacy in adjuvant and metastatic settings for colorectal and breast cancers
• Can be used as monotherapy or in combination with other chemotherapeutic or targeted agents

Common use

Xeloda is indicated for:

• Adjuvant treatment of patients with Dukes’ C colon cancer who have undergone complete resection of the primary tumor when fluoropyrimidine therapy alone is preferred.
• First-line treatment of patients with metastatic colorectal carcinoma.
• Treatment of patients with metastatic breast cancer resistant to both paclitaxel and an anthracycline-containing chemotherapy regimen, or resistant to paclitaxel and for whom further anthracycline therapy is not indicated.
• In combination with docetaxel for the treatment of patients with metastatic breast cancer after failure of prior anthracycline-containing chemotherapy.
• Off-label uses may include treatment of gastric cancer, pancreatic cancer, and other malignancies where fluoropyrimidines are indicated, based on physician discretion and emerging clinical evidence.

Dosage and direction

The recommended dosage of Xeloda must be individualized based on body surface area, clinical indication, and tolerance. The standard monotherapy dose is 1250 mg/m² administered orally twice daily (morning and evening) for 2 weeks followed by a 1-week rest period, constituting a 3-week treatment cycle. Tablets should be swallowed whole with water within 30 minutes after a meal. Doses are typically rounded to the nearest tablet strength (150 mg or 500 mg) to provide the closest possible dose to the calculated requirement. Dosage adjustments are frequently necessary based on toxicity; refer to the full prescribing information for detailed dose modification guidelines. Treatment should continue until disease progression or unacceptable toxicity occurs.

Precautions

• Patients should be closely monitored for severe diarrhea, as dehydration and renal impairment may rapidly ensue; initiate supportive care and interrupt treatment promptly for moderate to severe diarrhea.
• Cardiotoxicity including myocardial infarction, angina, dysrhythmias, and cardiac arrest has been reported; use with caution in patients with pre-existing cardiac disease.
• Concomitant administration with warfarin requires frequent monitoring of INR and prothrombin time due to risk of bleeding and elevated INR.
• Dihydropyrimidine dehydrogenase (DPD) deficiency may lead to severe, life-threatening toxicity; although routine screening is not standard, consider testing in patients with unusual toxicity.
• Hyperbilirubinemia requires dose modification; monitor liver function tests regularly.
• Hand-and-foot syndrome (palmar-plantar erythrodysesthesia) is common and may require treatment interruption, dose reduction, or discontinuation.
• Advise patients to use effective contraception during and for months after treatment completion due to risks of fetal harm.

Contraindications

• Known severe hypersensitivity to capecitabine, 5-fluorouracil, or any component of the formulation.
• Known complete absence of dihydropyrimidine dehydrogenase (DPD) activity.
• Severe renal impairment (creatinine clearance below 30 mL/min as calculated by Cockcroft-Gault).
• Pregnancy and breastfeeding.

Possible side effect

Common adverse reactions (≥10%) include:

• Diarrhea
• Hand-and-foot syndrome (painful redness, swelling, and blistering of palms and soles)
• Nausea, vomiting
• Stomatitis
• Fatigue
• Anorexia
• Hyperbilirubinemia
• Dermatitis

Serious side effects requiring immediate medical attention:

• Severe diarrhea, nausea, vomiting leading to dehydration
• Signs of hand-and-foot syndrome progressing to blistering, peeling, or severe pain
• Symptoms of cardiotoxicity (chest pain, arrhythmias, shortness of breath)
• Fever, infection, or signs of neutropenia
• Severe stomatitis preventing oral intake
• Signs of DPD deficiency-related toxicity (early onset of severe gastrointestinal, neurological, or hematological toxicity)

Drug interaction

• Warfarin: Xeloda may significantly increase INR and risk of bleeding; monitor coagulation parameters frequently.
• Phenytoin: Capecitabine may increase phenytoin levels; monitor phenytoin levels and adjust dose accordingly.
• Leucovorin: Enhances the toxicity of fluoropyrimidines; combination may increase incidence and severity of adverse effects.
• Allopurinol: May decrease the efficacy of capecitabine; generally avoid concomitant use.
• Antacids: May alter absorption; administer at different times if possible.
• Live vaccines: Avoid administration during treatment due to immunosuppression.

Missed dose

If a dose is missed, skip that dose and take the next dose at its regularly scheduled time. Do not take double or extra doses to make up for a missed dose. Inform your healthcare provider of any missed doses, particularly if multiple doses are missed.

Overdose

Overdose may lead to severe nausea, vomiting, diarrhea, gastrointestinal irritation and bleeding, bone marrow suppression, and acute neurological toxicity. There is no specific antidote for capecitabine overdose. Treatment consists of immediate discontinuation of the drug and initiation of supportive measures, including aggressive hydration, antiemetics, antidiarrheals, and hematological support. Hemodialysis is unlikely to be effective due to high protein binding and extensive metabolism.

Storage

Store at room temperature (20°C to 25°C or 68°F to 77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F). Keep in the original container, tightly closed, and protect from moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Dispose of unused medication through a medicine take-back program or according to local regulations.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment decisions. Dosage, indications, and safety information may change; refer to the latest official prescribing information for current recommendations. Individual patient responses and tolerances may vary significantly.

Reviews

“Xeloda provided a manageable oral option for my adjuvant colon cancer treatment. The convenience was significant, though hand-foot syndrome required careful dose management.” — Oncology patient, 62

“As an oncologist, I value Xeloda for its efficacy in metastatic breast cancer and its role in sequential therapy. The predictable toxicity profile allows for outpatient management in most compliant patients.” — Medical oncologist, 15 years experience

“While the gastrointestinal side effects were challenging, being able to continue working during treatment made a significant difference in my quality of life compared to my previous IV chemotherapy.” — Metastatic colorectal cancer patient, 54

“The combination of capecitabine and docetaxel remains a standard option for HER2-negative metastatic breast cancer. The oral administration facilitates long-term disease control with periodic monitoring.” — Clinical researcher, breast oncology