Side Effects of Capecitabine (Xeloda)
Capecitabine, also known as the brand name Xeloda, is a cancer medication used to treat breast and colorectal cancer. Capecitabine is part of the drug class antineoplastics and inhibits cancer cell growth which are removed by the body. Cancer cell growth may be affected by other medications resulting in side effects.
Uses of Xeloda
Xeloda is used in treatment for patients with Dukes’ C colon cancer or colerectal cancer (colon cancer that has spread to lymph nodes in the area close to the colon) after having surgery. Xeloda is an orally administered systemic prodrug of 5’-deoxy-5-fluorouridine (5’-DFUR). It is converted to 5-fluorouracil (5′-FU) to those who have resection of the primary tumor and first-line treatment of patients with metastatic colorectal cancer when treatment with fluoropyrimidine therapy alone is preferred.
Xeloda is also utilizied with docetaxel for breast cancer. It is used after failure of prior anthracycline-containing chemotherapy. Xeloda is resistant to both paclitaxel (anti-cancer drug) and an anthracycline-containing combination chemotherapy. Xeloda is given when other cancer medicines do not function or when patients cannot take other cancer medicines.
Serious Side Effects
Some of the serious side effects described by the FDA of Xeloda are gastrointestinal and dermatologic effects.
Gastrointestinal side effects include:
- Diarrhea (with or without abdominal cramp) is the most common and dangerous side effect
- Stomatitis (painful inner mouth swelling and sores)
- Neutropenia (low white blood cell count)
- Neurotoxicity (damage to the brain or nervous system)
- Abdominal pain or dyspepsia (pain in the upper part of stomach)
- Ileus (lack of movement in the intestines that can lead to blockage of food)
The side effects stomatitis, diarrhea, neutropenia, and neurotoxicity are associated with 5-FU and has been attributed to a deficiency of dihydropyrimidine dehydrogenase (DPD) activity. Serious dermatologic side effects reported by the FDA are hand-foot syndrome (also knows palmar-plantar erythrodysesthesia or chemotherapy-induced acral erythema (reddening, swelling, and pain on the palms of hands or soles of the feet), alopecia (spot baldness), rash, erythema (red patches on this skin).
Hand-foot syndrome’s symptoms can be categorized from grade 1 to 3. Grade 1’s symptoms are tingling; numbness, painless swelling, or erythema in the hands or feet and discomfort that does not disrupt normal activities. The symptoms of Grade 2 are swelling of hands or feet and discomfort affecting the patient’s daily activities, and painful erythema. Grade 3 is defined as ulceration (open sore or wound on the skin), moist desquamation (skin peeling), blistering, severe pain of the hands and feet, or severe discomfort that prevents the patient from completing daily activities. Xeloda treatment should be stopped if grade 2 or 3 hand-and-foot syndrome occurs until the symptoms clear up or decrease in intensity to grade 1.
Xeloda can also cause myocardial infarction (heart attack), ischemia (reduced blood flow to the heart), angina (chest pain), dysrhythmias (irregular heartbeat), cardiac arrest, cardiac failure, sudden death, electrocardiographic changes, and cardiomyopathy (heart muscle disease). These adverse events may be more common in patients with a prior history of coronary artery disease. Other serious side effects are granulocytopenia (decreased number of granulocytes) and anemia (Xeloda label reported by the FDA).
In addition, the FDA reports patients 80 years old or older may experience a greater incidence of adverse events. Xeloda is harmful in patients with known dihydropyrimidine dehydrogenase (DPD) deficiency. This can lead to severe and inflammation of the lining of the gastrointestinal tract. Xeloda treatment can also be risky for patients with severe kidney failure.
Common Side Effects:
Common side effects of Xeloda are:
- Taste loss
- Paresthesia (burning sensation)
- Peripheral neuropathy (weakness and numbness form nerve damage)
- Hypoesthesia (loss of touch or numbness)
- Dyspnea (difficulty in breathing)
- Sore throat
- Epistaxis (nose bleeding)
Other side effects are fatigue, pyrexia (fever), asthenia (lack of energy) or lethargy, anorexia, eye irritation, back pain, arthralgia (joint pain), depression, mood alteration, and bacterial infections.
Rare side effects of capecitabine are hyperbilirubinemia (too much bilirubien in the blood), increased SGPT (enzyme released into the blood), increased/decreased calcium, reduction in lymphocytes, decreased neutrophils, decreased hemoglobin, decreased platelets.
Patients receiving concomitant capecitabine and oral coumarin-derivative anticoagulant therapy should have their anticoagulant response (INR or prothrombin time) monitored frequently in order to adjust the anticoagulant dose accordingly.
About Pharmacogenetic Testing
Xeloda is converted to fluorouracil by the enzymes thymidine phosphorylases (dThdPase). Thymidine phosphorylase then hydrolyzes 5’-DFUR to 5-FU. Thymidine phosphorylase is expressed in higher numbers in various tumors.
Knowledge of these genetic variants will allow the prescriber and patient to find the right treatment plan.
Know Your Genetic Risk with the Rxight® Genetic Test
The Rxight® pharmacogenetic test sequences a panel of 18 genes on 60 alleles to analyze individual genetic differences in drug responses. This allows the pharmacist and patient to see how medications affect the body and design the best treatment, see which medications are not useful or harmful, and prevent severe side effects
Contributors to this Article:
Michael Sapko, MD, PhD; and Deborah Kallick, PhD, Medicinal Chemistry
Read more about Rxight® Genetic Health Testing