Xeloda: Targeted Oral Chemotherapy for Advanced Cancers
Xeloda
| Product dosage: 500mg | |||
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| 50 | $15.76
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Synonyms | |||
Xeloda (capecitabine) is an orally administered prodrug chemotherapy agent specifically designed for targeted activation within tumor tissue. As a fluoropyrimidine carbamate, it offers a sophisticated mechanism of action that converts to 5-fluorouracil (5-FU) preferentially at the tumor site, maximizing anticancer activity while potentially minimizing systemic exposure. This innovative approach provides a convenient oral alternative to traditional intravenous fluoropyrimidine regimens, allowing for treatment continuity outside clinical settings. It is indicated for adjuvant and metastatic colorectal cancer, metastatic breast cancer, and gastric cancer, representing a cornerstone in modern oncology therapeutics.
Features
- Oral tablet formulation available in 150 mg and 500 mg strengths
- Prodrug selectively activated to 5-fluorouracil by thymidine phosphorylase in tumor tissues
- Dosing regimen typically administered for 14 days followed by 7-day rest period
- Bioavailability of nearly 100% when taken with food
- Hepatic metabolism with renal excretion of primary metabolites
Benefits
- Enables convenient home-based administration, reducing hospital visits and improving quality of life
- Demonstrates targeted activation within tumor tissue, potentially enhancing efficacy while limiting systemic toxicity
- Provides flexible dosing adjustable to individual patient tolerance and response
- Offers established efficacy in multiple cancer types with well-characterized safety profile
- Allows for combination therapy with other anticancer agents including radiation therapy
- Maintains therapeutic activity while potentially reducing certain traditional chemotherapy side effects
Common use
Xeloda is primarily indicated for the adjuvant treatment of patients with Dukes’ C colon cancer who have undergone complete resection of the primary tumor when fluoropyrimidine therapy alone is preferred. It is also approved for first-line treatment of metastatic colorectal carcinoma, either as monotherapy or in combination with other chemotherapeutic agents. In metastatic breast cancer, Xeloda is indicated for patients resistant to both paclitaxel and an anthracycline-containing chemotherapy regimen, or resistant to paclitaxel when further anthracycline therapy is not indicated. Additionally, it is used in the treatment of gastric cancer, often in combination regimens. The medication may be used off-label for other malignancies where fluoropyrimidine therapy is appropriate, based on clinical evidence and oncologist discretion.
Dosage and direction
The recommended dosage of Xeloda is 1250 mg/m² administered orally twice daily (morning and evening) for 14 days followed by a 7-day rest period, constituting a 21-day treatment cycle. Tablets should be taken within 30 minutes after a meal with water. Dosage adjustments are based on body surface area and should be calculated prior to initiating therapy. For patients with moderate renal impairment (creatinine clearance 30-50 mL/min), the recommended starting dose is 75% of the standard dose. Severe renal impairment (creatinine clearance <30 mL/min) contraindicates Xeloda use. Treatment should continue until disease progression or unacceptable toxicity occurs. Dose modifications are implemented based on toxicity grading, with specific guidelines for hand-foot syndrome, diarrhea, nausea, vomiting, stomatitis, and hematologic toxicities.
Precautions
Patients should be closely monitored for diarrhea, as severe diarrhea may necessitate treatment interruption and dose reduction. Dehydration should be promptly corrected. Cardiotoxicity including myocardial infarction, angina, dysrhythmias, and cardiac arrest have been reported; patients with pre-existing cardiac disease require careful monitoring. Xeloda may cause fetal harm and should not be used during pregnancy unless potential benefits justify potential risks. Nursing mothers should discontinue breastfeeding during treatment. Hepatic impairment due to liver metastases may increase systemic exposure; careful monitoring is advised. Patients with dihydropyrimidine dehydrogenase (DPD) deficiency may experience severe, life-threatening toxicity; consideration of DPD testing is recommended. Concomitant use with warfarin requires frequent monitoring of INR and PT due to increased risk of bleeding.
Contraindications
Xeloda is contraindicated in patients with known hypersensitivity to capecitabine or any component of the formulation. It must not be administered to patients with severe renal impairment (creatinine clearance below 30 mL/min as calculated by Cockcroft-Gault equation). Patients with known complete absence of dihydropyrimidine dehydrogenase (DPD) activity should not receive Xeloda. Concomitant administration with sorivudine or its chemically related analogues is absolutely contraindicated due to risk of severe and potentially fatal toxicity. The medication is contraindicated in patients who have exhibited previous severe reactions to fluoropyrimidine therapy.
Possible side effect
The most common adverse reactions (≥10%) include diarrhea, hand-foot syndrome, nausea, vomiting, abdominal pain, fatigue, anorexia, stomatitis, fever, dizziness, headache, dyspnea, constipation, rash, and edema. Laboratory abnormalities may include hyperbilirubinemia, anemia, neutropenia, thrombocytopenia, lymphopenia, and increased alkaline phosphatase. Serious adverse reactions include severe diarrhea requiring hospitalization, hand-foot syndrome necessitating dose modification, cardiotoxicity, neutropenia, thrombocytopenia, hyperbilirubinemia, severe skin reactions, and embryofetal toxicity. Less common but significant effects include dehydration secondary to diarrhea, infections in neutropenic patients, and ocular irritations including corneal alterations.
Drug interaction
Xeloda interacts significantly with warfarin, increasing anticoagulant effect and risk of bleeding through undefined mechanisms requiring frequent INR monitoring. Phenytoin levels may increase due to inhibition of CYP2C9 by capecitabine metabolites. Concomitant administration with leucovorin increases concentrations of 5-fluorouracil, potentially enhancing both efficacy and toxicity. Allopurinol may decrease efficacy of capecitabine by inhibiting its activation. Antacids containing aluminum and magnesium may alter absorption characteristics. Sorivudine and related analogues are absolutely contraindicated due to potential fatal toxicity from inhibition of DPD. Other bone marrow suppressants may enhance myelosuppressive effects requiring careful monitoring.
Missed dose
If a dose is missed, the patient should not take the missed dose at the next scheduled time. Instead, they should continue with the regular dosing schedule and inform their healthcare provider. Doubling the dose to make up for a missed dose is strictly prohibited as this may significantly increase toxicity. If vomiting occurs after tablet ingestion, the patient should not take additional tablets to replace the vomited dose but should continue with the next scheduled dose. Healthcare providers should be notified of missed doses to assess potential impact on treatment efficacy and schedule.
Overdose
Xeloda overdose would be expected to produce manifestations of 5-fluorouracil toxicity including severe nausea, vomiting, diarrhea, gastrointestinal irritation and bleeding, bone marrow suppression, and neurological toxicity. Management consists of immediate discontinuation of the drug and institution of supportive care. Hematologic parameters should be monitored for at least four weeks. Administration of pyridoxine (vitamin B6) may ameliorate the severity of hand-foot syndrome. Dialysis may be considered though the effectiveness in removing capecitabine and its metabolites is not well established. Treatment should be symptomatic and supportive with particular attention to fluid and electrolyte balance, infectious complications, and hematological parameters.
Storage
Xeloda tablets should be stored at room temperature between 15°C to 30°C (59°F to 86°F) in their original container with the lid tightly closed. The medication must be kept away from moisture and light and should not be stored in bathroom cabinets or other humid areas. Tablets should be kept out of reach of children and pets. Unused medication should be disposed of properly through take-back programs or medication disposal systems. Tablets should not be used beyond the expiration date printed on the packaging. The blister packs provide protection from moisture and should not be transferred to other containers.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions must be made by qualified healthcare professionals based on individual patient circumstances. The prescribing information provided here may not include all possible uses, directions, precautions, or interactions. Patients should consult their healthcare provider for complete information about their specific medical condition and treatment options. Actual clinical use may differ from the information presented based on evolving clinical evidence and individual patient factors.
Reviews
Clinical studies demonstrate that Xeloda achieves response rates of approximately 25-30% in metastatic colorectal cancer as monotherapy, with combination regimens showing improved outcomes. In breast cancer, response rates of 15-25% have been observed in anthracycline- and taxane-resistant patients. The convenience of oral administration receives positive patient feedback in quality-of-life assessments, though management of hand-foot syndrome remains a significant consideration in treatment satisfaction. Oncologists appreciate the flexibility of oral dosing and the established efficacy profile, though careful patient education regarding toxicity management is emphasized. Clinical trial data supports its position as a valuable option in the oncology armamentarium with a predictable safety profile when appropriately managed.