Capecitabine

Capecitabine is an oral chemotherapy drug being studied in various clinical trials for different types of cancer. These trials aim to evaluate its effectiveness, safety, and optimal dosing when used alone or in combination with other treatments. The research focuses on cancers such as rectal, gastric, biliary tract, and breast cancer, exploring capecitabine’s potential in neoadjuvant, adjuvant, and metastatic settings.

Table of Contents

What is Capecitabine?

Capecitabine, also known by its brand names Xeloda or Xeloda, is an oral medication used in cancer treatment[1]. It belongs to a class of drugs called fluoropyrimidine carbamates, which are designed to interfere with cancer cell growth[2]. Capecitabine is what’s known as a prodrug, which means it’s inactive when you take it, but your body converts it into an active form of the medication called fluorouracil (5-FU) once it reaches the tumor site[1].

What Conditions Does Capecitabine Treat?

Capecitabine is used to treat several types of cancer, including:

  • Colorectal Cancer: Including metastatic colorectal cancer (cancer that has spread to other parts of the body)[3]
  • Breast Cancer: Particularly HER2+ metastatic breast cancer[1]
  • Gastric (Stomach) Cancer: Including advanced and metastatic forms[2]
  • Gastroesophageal Junction Adenocarcinoma: Cancer that occurs where the esophagus meets the stomach[2]
  • Anal Canal Cancer: Used in combination with other treatments[4]

How Does Capecitabine Work?

Capecitabine works by interfering with the DNA production of cancer cells. When you take the medication, your body converts it into 5-FU at the tumor site. This active form of the drug then blocks an enzyme called thymidylate synthase, which is necessary for DNA replication. By doing this, capecitabine stops cancer cells from dividing and growing[2].

In some treatment regimens, capecitabine is used in a “metronomic” approach. This means it’s given in lower doses but more frequently, which may help to prevent the growth of blood vessels that feed tumors (a process called angiogenesis)[3].

How is Capecitabine Administered?

Capecitabine is taken orally in the form of tablets. The dosage and schedule can vary depending on the specific treatment plan, but some common approaches include:

  • Twice daily dosing, often for 14 days followed by a 7-day rest period[1]
  • Continuous daily dosing in some metronomic regimens[3]
  • Dosages are typically calculated based on body surface area (BSA)[2]

It’s important to take capecitabine exactly as prescribed by your doctor. The tablets should be swallowed whole with water within 30 minutes after a meal[1].

Capecitabine in Combination Therapies

Capecitabine is often used in combination with other cancer treatments to enhance its effectiveness. Some common combinations include:

  • Capecitabine + Docetaxel: Used in treating advanced gastric cancer[2]
  • Capecitabine + Oxaliplatin + Irinotecan + Bevacizumab: Used in treating colorectal cancer liver metastases[5]
  • Capecitabine + Mitomycin + Panitumumab: Used with radiation therapy in treating anal canal cancer[4]
  • Capecitabine + Neratinib or Lapatinib: Used in treating HER2+ metastatic breast cancer[1]

Potential Side Effects

Like all medications, capecitabine can cause side effects. Some common side effects may include:

  • Diarrhea
  • Nausea and vomiting
  • Hand-foot syndrome (redness, swelling, and pain on the palms of hands and soles of feet)
  • Fatigue
  • Loss of appetite

Your healthcare team will monitor you closely for these and other potential side effects. It’s important to report any new symptoms or changes in your health to your doctor promptly[1].

Ongoing Research and Clinical Trials

Researchers continue to study capecitabine to find new ways to use it effectively. Some areas of ongoing research include:

  • Using capecitabine in combination with immunotherapy drugs like avelumab for treating rectal cancer[6]
  • Exploring metronomic dosing of capecitabine in various cancer types[3]
  • Investigating capecitabine as part of perioperative treatment (treatment given before and after surgery) for colorectal cancer liver metastases[5]
  • Studying capecitabine in combination with newer targeted therapies for breast cancer[1]

These ongoing studies aim to improve the effectiveness of capecitabine and expand its use to benefit more patients with various types of cancer.

Aspect Details
Cancer Types Studied Rectal cancer, gastric cancer, biliary tract cancer, triple-negative breast cancer
Treatment Settings Neoadjuvant (before surgery), adjuvant (after surgery), metastatic disease
Combination Therapies Radiotherapy, other chemotherapy drugs (e.g., gemcitabine, oxaliplatin), targeted therapies (e.g., bevacizumab, trastuzumab)
Dosing Strategies Standard dosing (e.g., 1000-1650 mg/m2/day), metronomic dosing (e.g., 650 mg/m2 twice daily for 1 year)
Primary Outcomes Progression-free survival, pathological complete response, disease-free survival
Secondary Outcomes Overall survival, tumor response rate, toxicity profile, quality of life
Patient Populations Various age groups, including elderly patients (over 70 years old in some studies)
Trial Phases Phase I, II, and III studies represented

Ongoing Clinical Trials on Capecitabine

  • Study on Post-Surgery Treatment for Colon Cancer Patients Using Trifluridine, Irinotecan, and Drug Combination

    Not yet recruiting

    2 1 1 1
    Italy
  • Study on Capecitabine and Oxaliplatin for High-Risk Rectal Cancer Patients to Reduce Metastases

    Not yet recruiting

    3 1 1 1
    Investigated Diseases:
    Investigated Drugs:
    Finland
  • Study on the Effectiveness of Oxaliplatin or Gemcitabine Chemotherapy in Patients with Resected Pancreatic Cancer Using Standard or Genetic Allocation Methods

    Not yet recruiting

    3 1 1 1
    Investigated Diseases:
    Germany Sweden
  • Study on Bevacizumab and Drug Combination for Patients with Resectable Colorectal Peritoneal Metastases

    Not yet recruiting

    4 1 1 1
    Belgium The Netherlands
  • Study of Durvalumab with Drug Combination for Patients with Locally Advanced Rectal Cancer

    Not yet recruiting

    2 1 1 1
    Investigated Diseases:
    Spain
  • Study Comparing Short-Course and Long-Course Chemotherapy with mFOLFIRINOX or PAXG for Patients with Stage I-III Pancreatic Cancer

    Not yet recruiting

    3 1 1 1
    Investigated Diseases:
    Italy
  • Study on the Effectiveness of Fluorouracil, Levoleucovorin, and Oxaliplatin in Patients with Resected Small Bowel Adenocarcinoma

    Not yet recruiting

    3 1 1 1
    Investigated Diseases:
    Belgium
  • Study of Datopotamab Deruxtecan with or without Durvalumab compared to standard treatment for patients with Stage I-III triple-negative breast cancer who have remaining cancer after initial therapy

    Not recruiting

    3 1 1 1
    Investigated Diseases:
    Belgium Denmark France Germany Greece Italy +2
  • Study of zolbetuximab, pembrolizumab and chemotherapy in adults with HER2-negative, Claudin 18.

    Not recruiting

    3 1 1
    Belgium Czechia France Germany Italy Lithuania +5
  • Study on the Effectiveness and Safety of Datopotamab Deruxtecan Compared to Chemotherapy in Adults with Advanced Triple-negative Breast Cancer

    Not recruiting

    3 1 1 1
    Investigated Diseases:
    Belgium France Germany Hungary Italy Poland +1

Glossary

  • Neoadjuvant therapy: Treatment given before the main treatment, usually before surgery, to shrink the tumor and make it easier to remove or treat.
  • Adjuvant therapy: Additional treatment given after the primary treatment (usually surgery) to lower the risk of cancer coming back.
  • Pathological complete response (pCR): The absence of any detectable cancer cells in the tissue removed during surgery after neoadjuvant therapy.
  • Metastatic cancer: Cancer that has spread from its original site to other parts of the body.
  • Progression-free survival: The length of time during and after treatment that a patient lives without the cancer getting worse.
  • Overall survival: The length of time from the start of treatment or diagnosis that patients are still alive.
  • Dose-limiting toxicity: Side effects severe enough to prevent an increase in the dose of a drug or that require a reduction in the dose.
  • HER2: Human Epidermal Growth Factor Receptor 2, a protein that can play a role in the development of some breast cancers.
  • Triple-negative breast cancer: A type of breast cancer that lacks receptors for estrogen, progesterone, and HER2, making it more challenging to treat.
  • Metronomic chemotherapy: A method of giving low doses of chemotherapy drugs on a frequent or continuous schedule, with the aim of reducing side effects while maintaining effectiveness.

References

  1. https://clinicaltrials.gov/study/NCT01808573
  2. https://clinicaltrials.gov/study/NCT02007148
  3. https://clinicaltrials.gov/study/NCT01668680
  4. https://clinicaltrials.gov/study/NCT01843452
  5. https://clinicaltrials.gov/study/NCT02086656
  6. https://clinicaltrials.gov/study/NCT03854799