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Section 2
Risk and Benefits of Capecitabine
in Metastatic Disease
SIDE EFFECT
PROFILE, DOSE, SCHEDULE
The oral formulation
really is important, because it’s very disruptive for patients
to come to the clinic and get IVs. The visits are shorter, patients
see me less often, and they can take their therapy at home. So,
it fits much better with having a normal life. Not having alopecia
with capecitabine is also very important for a lot of my patients.
They’re willing to take therapies that cause alopecia, but
if it’s a choice between losing their hair or not, that’s
a big advantage.
Not having to
worry about myelosuppression is also a big advantage, and we have
not had a lot of trouble with nausea with capecitabine, particularly
if we’ve decreased the dose or spread out the schedule. So
it really has not slowed down my patients. Chronic fatigue has also
been less with capecitabine than with some of the other chemotherapeutic
agents. Most of my patients who have been on other chemotherapies
beforehand generally describe capecitabine as being the easiest
treatment they’ve had. Our patients start out at a total daily
dose of 2,000 mg/m2 with the traditional two-week on,one-week off
schedule.
—Kathy
M i l l e r, MD
I try to do
things preventatively, and there are some anecdotal small studies
reporting some benefit with Vitamin B-6 (pyridoxine), 13 and the
use of thick emollients 14 in preventing the hand-foot syndrome
associated with capecitabine. There’s also some ongoing clinical
research looking at nicotine patches to decrease the chance of hand-foot
syndrome, but I don’t know whether that’s effective. Apparently,
the capillaries in the thick palms and soles are very different
than others and go quite deep into the dermis. And so it may be
that some metabolites of capecitabine are becoming stuck down there
in higher concentrations. That mechanism has been cited as a potential
reason that the soles and palms are singled out for the hand-foot
syndrome toxicity, but that’s speculation.
—Joyce
O’Shaughnessy, MD
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