Capecitabine

Name	Capecitabine
Classes	Anticancer/Antineoplastic Agent Antimetabolites
Diseases	Breast Cancer Cancer Colon Cancer Colorectal Cancer

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Capecitabine

Capecitabine is an antineoplastic agent from the class called the antimetabolites. In vivo, enzymes convert capecitabine to 5-fluorouracil (5-FU). 5-FU is metabolized by both normal and tumor cells to 5-fluoro-2'-deoxyuridine monophosphate (FdUMP) and 5-fluouridine triphosphate (FUTP). These metabolites harm cells through two distinct mechanisms which ultimately inhibits the production of thymidylate, RNA & proteins.

Indication and Usage

Capecitabine is a nucleoside metabolic inhibitor with antineoplastic activity indicated for:

Adjuvant Colon Cancer

Patients with Dukes’ C colon cancer

Metastatic Colorectal Cancer

First-line as monotherapy when treatment with fluoropyrimidine therapy alone is preferred

Metastatic Breast Cancer

In combination with docetaxel after failure of prior anthracycline containing therapy
As monotherapy in patients resistant to both paclitaxel and an anthracycline-containing regimen

Dosage & Administration (How to take this medication)

Take Capecitabine with water within 30 min after a meal
Monotherapy: 1250 mg/m² twice daily orally for 2 weeks followed by a one week rest period in 3-week cycles
Adjuvant treatment is recommended for a total of 6 months (8 cycles)
In combination with docetaxel, the recommended dose of Capecitabine is 1250 mg/m² twice daily for 2 weeks followed by a 7-day rest period, combined with docetaxel at 75 mg/m² as a 1-hour IV infusion every 3 weeks
Capecitabine dosage may need to be individualized to optimize patient management
Reduce the dose of Capecitabine by 25% in patients with moderate renal impairment

Side effect

Most common adverse reactions were-

Diarrhea	Nausea	Vomiting
Abdominal Pain	Asthenia	Jaundice

Precaution/Good to know

Coagulopathy: May result in bleeding, death. Monitor anticoagulant response (e.g., INR) and adjust anticoagulant dose accordingly.
Cardiotoxicity: Common in patients with a prior history of coronary artery disease.
Diarrhea: May be severe. Interrupt Capeciabine treatment immediately until diarrhea resolves or decreases to grade 1. Recommend standard antidiarrheal treatments.
Increased Risk of Severe or Fatal Adverse Reactions in Patients with Lo w or Absent Dihydropyrimidine Dehydrogenase (DPD) Activity: Withhold or permanently discontinue Capeciabine in patients with evidence of acute early-onset or unusually severe toxicity, which may indicate near complete or total absence of DPD activity. No Capeciabine dose has been proven safe in patients with absent DPD activity.
Dehydration and Renal Failure: Interrupt Capeciabine treatment until dehydration is corrected. Potential risk of acute renal failure secondary to dehydration. Monitor and correct dehydration.
Pregnancy: Can cause fetal harm. Advise women of the potential risk to the fetus.
Mucocutaneous and Dermatologic Toxicity: Severe mucocutaneous reactions, Steven-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), have been reported. Capeciabine should be permanently discontinued in patients who experience a severe mucocutaneous reaction during treatment. Capeciabine may induce hand-and-foot syndrome. Interrupt Capeciabine treatment until the hand-and-foot syndrome event resolves or decreases in intensity.
Hyperbilirubinemia: Interrupt Capeciabine treatment immediately until the hyperbilirubinemia resolves or decreases in intensity.
Hematologic: Do not treat patients with neutrophil counts <1.5 x 10⁹/L or thrombocyte counts <100 x 10⁹/L. If grade 3-4 neutropenia or thrombocytopenia occurs, stop therapy until condition resolves.