Capecitabine

Capecitabine (Xeloda) is an antimetabolite chemotherapy medicine used to treat metastatic breast cancer that grows despite treatment with certain other anticancer medicines.

How capecitabine works

Capecitabine is an inactive form of 5-fluorouracil, a chemotherapy medicine. When you take capecitabine, it stays inactive until it reaches your liver. Your liver and the enzymes in the cancer cells then convert the capecitabine to its active form. The active 5-fluorouracil then kills the cancer cells when they try to divide.

Who gets capecitabine

Capecitabine alone or with docetaxel (Taxotere) or paclitaxel (Taxol) are three of the many chemotherapy regimens that can be used to treat metastatic breast cancer. Capecitabine can also be used with lapatinib (Tykerb) for metastatic HER2-positive breast cancers.

If you need radiation therapy, capecitabine is usually used after you finish your radiation regimen. This is because it’s not yet clear how safe it is to give capecitabine and radiation at the same time in routine use.

How capecitabine is given

Capecitabine is given as a pill two times per day for 7 to 14 days followed by one week off, but your dose and schedule may be different.

Side effects and things to remember

Common side effects include:

• Decrease in appetite
• Dehydration
• Diarrhea
• Hand and foot syndrome
• Low red and white blood cell counts
• Fatigue
• Menopausal symptoms
• Mouth sores
• Nausea and vomiting

Less common side effects include:

• Constipation
• Eye problems
• Hair thinning or hair loss
• Nail changes
• Fertility problems

Before starting capecitabine, tell your doctor about any medicines you are taking, including vitamins, herbal supplements and over-the counter-medicines. You should not become pregnant while you are taking capecitabine.

If you have pain or diarrhea that bothers you, talk to your doctor right away. You may be able to take a lower dose of capecitabine that makes you more comfortable while keeping the treatment just as effective.

Your doctor, pharmacist or nurse can help you manage your side effects. You can also go to our section on Side Effects for more information.

Capecitabine and DPD deficiency

If you and your doctor are considering capecitabine as part of your treatment, it is important to know about a rare inherited genetic condition called DPD deficiency. Research has shown that total DPD deficiency is rare, occurring in fewer than 0.1% of people. Partial DPD deficiency has been reported in about 6.8-11.5% of people.

People with any level of DPD deficiency were born with an inherited mutation in the DYPD gene. Inherited DYPD gene mutations reduce the amount of DPD enzyme in the body. The DPD enzyme helps certain body processes, including the breakdown of capecitabine and fluorouracil chemotherapies.

People with DPD deficiency may be at risk for very serious reactions, including death, while taking capecitabine or fluorouracil. If you are considering capecitabine or fluorouracil, ask your care team about DPD deficiency.

Here are some questions to ask:

• Should I be tested for an inherited DYPD mutation?
• How can we work together to manage the risk of serious side effects while I’m taking this medicine?
• Is there a different chemotherapy option for me?