Capecitabine (Xeloda, Roche Products) is an orally administered pro-drug of fluorouracil. It is converted to fluorouracil by enzymes that are principally located in the liver and tumour tissue. This leads to a higher concentration of fluorouracil in tumour tissue than in normal tissues. Capecitabine has a UK marketing authorisation for the first-line treatment of advanced gastric cancer in combination with a platinum-based regimen.
According to the summary of product characteristics (SPC), contraindications include known dihydropyrimidine dehydrogenase deficiency, severe leucopenia, neutropenia or thrombocytopenia, severe hepatic impairment and severe renal impairment. The SPC states that capecitabine has been associated with hand–foot syndrome, diarrhoea, neutropenia, peripheral neuropathy, headache and alopecia. For full details of side effects and contraindications, see the SPC.
Capecitabine is administered orally. The recommended dose of capecitabine is 625 mg per m2 twice daily for 21 days if it is used as part of the epirubicin, cisplatin and capecitabine (ECX) regimen, or the epirubicin, oxaliplatin and capecitabine (EOX) regimen. If it is used as part of a capecitabine and cisplatin (CX) regimen, the recommended dose of capecitabine is 1,000 mg per m2 twice daily for 14 days in every 21 days. Treatment should be stopped if the disease gets worse or if there is intolerable toxicity. The cost of 60 150-mg tablets of capecitabine is £40.02 and the cost of 120 500-mg tablets is £265.55 (excluding VAT; Monthly Index of Medical Specialities [MIMS], March 2010). Costs may vary in different settings because of negotiated procurement discounts.