Xeloda for Metastatic Breast Cancer

Xeloda is the brand name for capecitabine. It is an oral chemotherapy (chemo) medication that treats metastatic breast cancer. Metastatic means the cancer has spread to other parts of the body.

As a breast cancer chemo pill, Xeloda may be given alone or combined with other anti-cancer medications. It is often prescribed after other chemotherapy does not work or when the cancer recurs, or returns. Xeloda can be used to treat colorectal (CRC) cancers too.

This article discusses Xeloda’s mechanism of action (how it works), along with its uses, dosage, side effects, risks, and contraindications.

Uses

Xeloda has been approved to treat metastatic breast cancer that has not responded to previous treatment, or when previous treatment has stopped working. Xeloda may be given alone or in combination with another medication such as Taxotere (docetaxel) or Tykerb (lapatinib).

Previous treatments include surgery, radiation, chemotherapy, or endocrine (hormone) therapy originally prescribed based on your type of breast cancer. For example, Xeloda is typically given when you have not responded to other chemotherapy medications such as Taxol (paclitaxel), Adriamycin (doxorubicin), or Taxotere (docetaxel).

Xeloda is considered for the following types of metastatic breast cancer:

• HER2-negative
• HER2-positive
• Triple-negative
• Hormone receptor-negative
• Hormone receptor-positive cancer (if endocrine therapy stops working)

Your healthcare team may consider Xeloda in specific circumstances. They include:

• After surgery to kill the remaining cancer cells (adjuvant treatment)
• When other treatment does not work
• When cancer returns
• For palliative treatment (to relieve symptoms when cancer is incurable)
  

Before Taking

Your healthcare team will evaluate your case to see if Xeloda is a good fit for you. This depends on the type, stage, and size of the cancer. It is also based on where the cancer has spread, previous treatment, and how you responded to that treatment.

Before starting Xeloda, you will receive education about the drug and how side effects can be managed. Your healthcare provider may order baseline blood tests or an electrocardiogram (ECG or EKG).

How It Works

Xeloda kills cancer cells by imitating part of a cancer cell’s genes. This makes the cell die before it can divide, which slows or stops cancer from growing. It is classified as an antimetabolite.

Efficacy

Efficacy refers to the effectiveness of a medicine. Studies show that Xeloda is an effective medication in the treatment of breast cancer. It helps to decrease the chance of cancer returning and prolongs survival for those with metastatic breast cancer.

This includes giving it alone, when combined with standard chemotherapy, as a post-surgical treatment, or in combination with either Taxotere or Tykerb.

Dosage and Schedule

Xeloda is an oblong, peach-colored pill given in either 150 milligram (mg) or 500 mg dosages. It’s generally taken twice a day, ideally about 30 minutes after a meal and with plenty of water.

The pills should not be crushed, chewed, or dissolved. If you miss a dose, you should wait until your next dose is due and take only that. You should not take an extra dose to compensate for the missed dose.

It’s taken on a cyclical dosage schedule that’s two weeks on, one week off, then two weeks on. Your healthcare provider will decide how long you’ll stay on this cycle.

Side Effects

Common side effects of Xeloda include:

• Diarrhea
• Nausea
• Vomiting
• Oral mucositis (sores in your mouth, tongue, and throat)
• Stomach pain
• Low appetite
• Dehydration
• Hand-foot syndrome
• Dizziness
  
• Fatigue
• Headache
• Swelling of the feet, ankles, or hands
• Neuropathy (tingling of fingers and toes)
• Weight loss

When taking Xeloda, try to stay hydrated by drinking more water and avoiding alcohol or caffeine, as these can dehydrate you. Ideally, you should get about 90 ounces of water per day. This includes water you get from food.

If you experience mouth or tongue sores, replace your usual toothbrush with a soft-bristled kind. There are also many other measures and food choices you can make to reduce this symptom.

If you experience dizziness, plan to take it easy. If you’re extremely nauseous, your healthcare provider may recommend anti-nausea medications to help you through.

The side effects of Xeloda may be different if you are taking it along with Taxotere or other chemotherapy drugs. Be sure to report all of your side effects to your healthcare provider. Note the dates and times they occur and the severity of each symptom.

Risks

Taking Xeloda with blood thinners such as Coumadin (warfarin) can cause your blood to thin more. This puts you at risk of bleeding more than usual, even with minor cuts.

Tell your healthcare provider if you take blood thinners. They may want to prescribe a lower dose of Xeloda or monitor your bloodwork more frequently.

To avoid common scrapes and scratches, consider wearing gloves while doing housework or gardening, protect your skin in cool weather, and switch to an electric razor.

In those 80 years old or older, Xeloda may cause more diarrhea, nausea, and vomiting than in younger people.

Hand-foot syndrome can occur with Xeloda. It often starts with darkening of the palms of the hands and soles of the feet. As it progresses, it can become more like a sunburn. There are several things you can do to help prevent this, including keeping your hands and feet cool, wearing good shoes, and not going barefoot.

Xeloda can cause photosensitivity, which means you may get a sunburn more easily. Consider the following precautions to help protect your skin:

• Avoid sun exposure if possible
• Use a good sunscreen
• Cover up using UV clothes, hats, or an umbrella

Since Xeloda can make you more susceptible to infections, it’s best to avoid situations that might put you at risk, such as crowded places and visiting ill friends.

Modifications

If you are in any of the following categories, your healthcare team may adjust your dose, monitor you more closely, or choose another medication:

• Pregnant or breastfeeding: Xeloda can cause harm to a baby during pregnancy. If you are of childbearing years, your healthcare provider will most likely have you take a pregnancy test before starting Xeloda. If you are pregnant, breastfeeding, or plan to get pregnant, talk to your provider about different treatment options.
• 65 or older: If you are 65 or older, the chance of having side effects or adverse reactions increases. Your healthcare team may want to monitor you more closely while you are taking this medication.
• Liver or kidney insufficiency: For those with hepatic (liver) or renal (kidney) insufficiency, your healthcare provider may choose to give a lower starting dose and monitor you closely.
• Pediatric: The safety and effectiveness of Xeloda have not been established for children.
  

Contraindications

You should not take Xeloda if you have the following:

• Severe renal impairment (creatinine clearance below 30 mL/min) 
• Hypersensitivity to Xeloda, to any of its components, or to Carac, Tolak, Efudex, Fluoroplex (5-fluorouracil or 5-FU)

Summary

Xeloda (capecitabine) is an oral chemotherapy medication that treats metastatic breast cancer. It can be given alone or in combination with other chemotherapy medications. Typically, it is given when other treatment does not work or stops working. It can also be used for colon and rectal cancers.

Xeloda kills cancer cells by imitating part of the cells’ genes. This stops or slows the cancer from growing. Side effects include diarrhea, nausea, vomiting, mouth sores, hand and foot syndrome, fatigue, and more. If any of these become severe, or you develop a fever, call your healthcare provider.

Those with severe kidney impairment or hypersensitivity to Xeloda or any of its components should not take this medication.