Uses

Indicated for the adjuvant treatment of Stage III colon cancer; perioperative treatment of locally advanced rectal cancer as part of chemoradiotherapy; treatment of unresectable or metastatic colorectal cancer; and treatment of advanced or metastatic breast cancer. Used as monotherapy or in combination regimens.

Do not use if

Contraindicated in patients with severe hypersensitivity to capecitabine or fluorouracil. Contraindicated with concurrent use of sorivudine or brivudine. Use with extreme caution in patients with DPD deficiency. Avoid in severe renal impairment (CrCl < 30 mL/min).

Side effects

Significant adverse effects include hand-foot syndrome (palmar-plantar erythrodysesthesia), diarrhea, nausea and vomiting, and myelosuppression. Cardiotoxicity (chest pain, arrhythmia) and renal toxicity may occur. Patients with complete DPD deficiency are at risk of serious or fatal toxicity.

Warnings

SERIOUS RISK in patients with complete DPD deficiency — test patients before initiating therapy. Increased bleeding risk with concomitant vitamin K antagonists (INR monitoring required). May cause severe diarrhea, dehydration, and hand-foot syndrome requiring dose reduction or discontinuation. Cardiotoxicity and renal toxicity have been reported.

How it works

Capecitabine is an oral prodrug of fluorouracil (5-FU) that is converted to 5-FU preferentially in tumor tissue through a cascade of three enzymatic steps. 5-FU inhibits thymidylate synthase (via FdUMP) and is incorporated into RNA (via FUTP), disrupting DNA synthesis and RNA processing, thereby inhibiting tumor cell proliferation.

Storage

Store at room temperature (20°C–25°C). Keep in original container, tightly closed. Protect from moisture.