Xeloda (capecitabine) is an orally administered prodrug chemotherapy agent specifically designed to deliver targeted, tumor-selective cytotoxicity. As a fluoropyrimidine carbamate, it offers a sophisticated mechanism of action by converting to 5-fluorouracil (5-FU) preferentially within tumor tissues, thereby maximizing therapeutic efficacy while potentially minimizing systemic exposure. This innovative approach provides a convenient, patient-centric alternative to traditional intravenous 5-FU regimens, supporting treatment continuity and quality of life. Xeloda is indicated for adjuvant and metastatic settings in colorectal cancer, metastatic breast cancer, and gastric cancer, often as part of combination therapy or as a single agent based on clinical guidelines and patient-specific factors.

Features

• Orally administered prodrug of 5-fluorouracil (5-FU)
• Tumor-selective activation via enzymatic conversion
• Available in 150 mg and 500 mg film-coated tablets
• Dosing regimen typically follows a 21-day cycle (14 days on, 7 days off)
• Requires functional metabolic pathway: conversion by carboxylesterase, cytidine deaminase, and thymidine phosphorylase
• Compatible with combination therapies including oxaliplatin, docetaxel, and radiation

Benefits

• Enables convenient home-based administration, reducing clinic visits and improving patient autonomy
• Provides targeted delivery of 5-FU directly to tumor sites, potentially enhancing efficacy and reducing off-target effects
• Offers flexible dosing adaptable to individual tolerance and treatment response
• Supported by extensive clinical evidence in gastrointestinal and breast malignancies
• May be used in both adjuvant and metastatic settings across multiple cancer types
• Facilitates maintenance therapy and long-term management in appropriate patients

Common use

Xeloda is commonly prescribed for:

• Adjuvant treatment of Dukes’ C colon cancer following complete resection of the primary tumor
• First-line treatment of metastatic colorectal carcinoma
• Treatment of metastatic breast cancer resistant to both paclitaxel and an anthracycline-containing regimen, or where further anthracycline therapy is not indicated
• First-line treatment of advanced gastric cancer in combination with platinum-based chemotherapy
• Off-label uses may include pancreatic cancer, biliary tract cancer, and other malignancies where fluoropyrimidine-based therapy is indicated

Dosage and direction

The recommended dosage of Xeloda should be individualized based on body surface area, clinical indication, and patient tolerance. Standard dosing is typically:

• 1250 mg/m² administered orally twice daily (morning and evening) for 2 weeks followed by a 1-week rest period, repeated every 3 weeks
• Tablets should be swallowed whole with water within 30 minutes after a meal
• Doses are typically rounded to the nearest tablet strength to achieve the calculated dose
• Dosage adjustments are required for renal impairment, hepatic dysfunction, and specific toxicities
• Treatment should continue until disease progression or unacceptable toxicity occurs

Dosage modifications are mandatory for:

• Grade 2 toxicities: interrupt treatment until resolution to Grade 0-1, then resume at reduced dose
• Grade 3 or 4 toxicities: interrupt immediately and consider dose reduction upon resolution
• Patients with creatinine clearance 30-50 mL/min: reduce starting dose by 25%
• Patients with creatinine clearance <30 mL/min: contraindicated

Precautions

Xeloda requires careful monitoring and management due to its potent cytotoxic effects:

• Regular monitoring of complete blood count, renal function, and liver enzymes is essential
• Patients with dihydropyrimidine dehydrogenase (DPD) deficiency may experience severe toxicity; consider testing in high-risk populations
• Monitor for signs of hand-foot syndrome (palmar-plantar erythrodysesthesia), which may require dose modification
• Use with caution in elderly patients due to increased risk of adverse reactions
• Cardiac monitoring is advised due to potential cardiotoxicity including myocardial infarction, angina, and arrhythmias
• Pregnancy Category D: may cause fetal harm; effective contraception required during and after treatment
• Nursing mothers should discontinue breastfeeding during treatment

Contraindications

Xeloda is contraindicated in patients with:

• Known hypersensitivity to capecitabine, 5-fluorouracil, or any component of the formulation
• Severe renal impairment (creatinine clearance below 30 mL/min)
• Known complete absence of dihydropyrimidine dehydrogenase (DPD) activity
• Concurrent administration with sorivudine or its chemically related analogues
• Pre-existing bone marrow suppression with neutrophil counts <1.5 × 10⁹/L or platelet counts <100 × 10⁹/L
• Severe hepatic impairment

Possible side effect

Common adverse reactions (≥10% incidence) include:

• Gastrointestinal: diarrhea (47-57%), nausea (34-43%), vomiting (15-22%), stomatitis (22-24%), abdominal pain (14-20%)
• Dermatological: hand-foot syndrome (54-60%), dermatitis (27-37%), rash (18-24%)
• Hematological: neutropenia (22-26%), thrombocytopenia (22-24%), anemia (72-80%)
• Constitutional: fatigue (42-46%), pyrexia (18-22%), asthenia (16-20%)
• Neurological: paresthesia (21-24%), headache (9-15%)

Serious adverse reactions requiring immediate medical attention:

• Severe diarrhea leading to dehydration and electrolyte imbalance
• Cardiotoxicity including myocardial ischemia and arrhythmias
• Severe hand-foot syndrome requiring dose interruption
• Neutropenic fever and serious infections
• Hyperbilirubinemia and hepatic toxicity
• Severe mucositis impairing oral intake

Drug interaction

Xeloda has several clinically significant drug interactions:

• Anticoagulants: increased risk of bleeding with warfarin (monitor INR closely)
• Phenytoin: increased phenytoin levels requiring therapeutic monitoring
• Leucovorin: enhances toxicity and efficacy of fluoropyrimidines
• Allopurinol: may decrease efficacy of capecitabine
• Live vaccines: contraindicated due to immunosuppression
• CYP2C9 substrates: potential interactions requiring dose adjustments
• Other myelosuppressive agents: additive bone marrow suppression

Missed dose

If a dose of Xeloda is missed:

• Do not take the missed dose if it is close to the next scheduled dose
• Resume the regular dosing schedule with the next dose
• Do not double the dose to make up for a missed dose
• Contact the healthcare provider for guidance if multiple doses are missed
• Maintain accurate dosing records to ensure treatment adherence

Overdose

Xeloda overdose may manifest as:

• Severe gastrointestinal toxicity (profuse diarrhea, nausea, vomiting)
• Myelosuppression with neutropenia and thrombocytopenia
• Neurological toxicity including confusion and cerebellar ataxia
• Cardiotoxicity and metabolic acidosis Management requires:
• Immediate discontinuation of Xeloda
• Hospitalization for supportive care
• Administration of uridine triacetate if available within 96 hours
• Aggressive hydration and electrolyte management
• Hematological support including growth factors and transfusions
• Monitoring and treatment of infectious complications

Storage

• Store at room temperature (20-25°C or 68-77°F)
• Keep in original container with lid tightly closed
• Protect from moisture and light
• Keep out of reach of children and pets
• Do not use if tablets show signs of deterioration or discoloration
• Properly dispose of unused medication through take-back programs

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Xeloda should only be used under the supervision of a qualified healthcare professional experienced in cancer chemotherapy. Treatment decisions must be based on individual patient characteristics, comprehensive clinical assessment, and current treatment guidelines. The prescribing physician should reference the complete prescribing information and consider all potential risks and benefits before initiating therapy. Patients should report any adverse reactions to their healthcare provider immediately.

Reviews

Clinical studies demonstrate Xeloda’s efficacy across multiple indications:

• XELOX regimen (Xeloda + oxaliplatin) shows non-inferiority to FOLFOX in metastatic colorectal cancer with improved convenience
• In adjuvant colon cancer, Xeloda demonstrated equivalent efficacy to bolus 5-FU/LV with different toxicity profile
• Combination with docetaxel in metastatic breast cancer showed superior time to progression compared to docetaxel alone
• Real-world evidence supports its tolerability and effectiveness in appropriately selected patients
• Quality of life assessments generally favor oral administration over intravenous alternatives

Ongoing research continues to explore Xeloda’s role in combination therapies, maintenance strategies, and additional cancer types, reinforcing its position as a valuable tool in medical oncology.