Indications
XELODA is indicated as a single agent for adjuvant treatment in patients with Dukes' C
colon cancer who have undergone complete resection of the primary tumor when treatment
with fluoropyrimidine therapy alone is preferred. XELODA was non-inferior to
5-fluorouracil and leucovorin (5-FU/LV) for disease-free survival (DFS). Although
neither XELODA nor combination chemotherapy prolongs overall survival (OS), combination
chemotherapy has been demonstrated to improve disease-free survival compared to 5-FU/LV.
Physicians should consider these results when prescribing single-agent XELODA in the
adjuvant treatment of Dukes' C colon cancer.
XELODA is indicated as first-line treatment
of patients with metastatic colorectal carcinoma when treatment with fluoropyrimidine
therapy alone is preferred. Combination chemotherapy has shown a survival benefit
compared to 5-FU/LV alone. A survival benefit over 5-FU/LV has not been demonstrated
with XELODA monotherapy. Use of XELODA instead of 5-FU/LV in combinations has not been
adequately studied to assure safety or preservation of the survival advantage.
XELODA monotherapy is indicated for the treatment of patients with metastatic breast
cancer resistant to both paclitaxel and an anthracycline-containing chemotherapy regimen
or resistant to paclitaxel and for whom further anthracycline therapy is not indicated,
eg, patients who have received cumulative doses of 400 mg/m of doxorubicin or doxorubicin
equivalents. Resistance is defined as progressive disease while on treatment, with or
without an initial response, or relapse within 6 months of completing treatment with an
anthracycline-containing adjuvant regimen.
XELODA in combination with docetaxel is indicated for the treatment of patients
with metastatic breast cancer after failure of prior anthracycline-containing chemotherapy.
Important Safety Information
WARNING
For patients receiving XELODA and warfarin concomitantly, frequent monitoring of
INR or prothrombin time (PT) is recommended. A clinically important drug interaction
between XELODA and warfarin has been demonstrated. Altered coagulation parameters
and/or bleeding and death have been reported. Clinically significant increases in
PT and INR have been observed within days to months after starting XELODA, and
infrequently within one month of stopping XELODA. These events occurred in patients
with and without liver metastases. Age greater than 60 and a diagnosis of cancer
independently predispose patients to an increased risk of coagulopathy.
Adverse Events
In XELODA monotherapy for colon cancer in the adjuvant setting, the most common adverse
events for all grades (>10%) in patients receiving either XELODA or 5-FU/LV (%;%)
were hand-foot syndrome (60;9), diarrhea (47;65), nausea (34;47), stomatitis (22;60),
fatigue (16;16), lethargy (16;15), vomiting (15;21), abdominal pain (14;16), asthenia
(10;10), anorexia (9;11), constipation (9;11), and alopecia (6;22). Grade 3/4 adverse
events (>5%) in patients receiving either XELODA or 5-FU/LV were hand-foot syndrome
(17;<1), diarrhea (12;14), stomatitis (2;14), and neutropenia (<1;5).
In XELODA monotherapy for metastatic colorectal cancer, the most common adverse events (>10%)
in patients receiving either XELODA or 5-FU/LV (%;%) were anemia (80;79), diarrhea (55;61), hand-foot syndrome
(54;6), hyperbilirubinemia (48;17), nausea (43;51), fatigue/weakness (42;46), abdominal pain (35;31),
dermatitis (27;26), vomiting (27;30), appetite decrease (26;31), stomatitis (25;62), pyrexia (18;21),
edema (15;9), constipation (14;17), dyspnea (14;10), neutropenia (13;46), pain (12;10), back pain
(10;9), headache (10;7), gastrointestinal motility disorder (10;7), oral discomfort (10;10),
upper GI inflammatory disorders (8;10), peripheral sensory neuropathy (10;4), taste disturbance
(6;11), and eye irritation (13;10). Grade 3/4 adverse events (>5%) in patients receiving either
XELODA or 5-FU/LV were hyperbilirubinemia (23;6), hand-foot syndrome (17;1), diarrhea (15;12), abdominal pain
(10;5), vomiting (5;5), ileus (5;3), stomatitis (3;15), and neutropenia (3;21).
In XELODA monotherapy for metastatic breast cancer, the most common adverse events (>10%)
in patients receiving XELODA (%) were lymphopenia (94), anemia (72), diarrhea (57), hand-foot
syndrome (57), nausea (53), fatigue (41), dermatitis (37), vomiting (37), neutropenia (26),
stomatitis (24), thrombocytopenia (24), anorexia (23), hyperbilirubinemia (22), paresthesia
(21), abdominal pain (20), constipation (15), eye irritation (15), and pyrexia (12).
Grade 3/4 adverse events (>5%) in patients receiving XELODA were lymphopenia (59),
diarrhea (15), hand-foot syndrome (11), hyperbilirubinemia (11), fatigue (8), stomatitis (7), and dehydration (5).
In XELODA combination therapy (XELODA plus docetaxel) for breast cancer, the most common adverse events (>10%)
in patients receiving either XELODA plus docetaxel or docetaxel alone (%;%) were
lymphocytopenia (99;98), leukopenia (91;88), neutropenia/granulocytopenia (86;87),
anemia (80;83), diarrhea (67;48), stomatitis (67;43), hand-foot syndrome (63;8), nausea
(45;36), alopecia (41;42), thrombocytopenia (41;23), vomiting (35;24), edema (33;34),
abdominal pain (30;24), pyrexia (28;34), asthenia (26;25), fatigue (22;27), constipation
(20;18), hyperbilirubinemia (20;6), neutropenic fever (16;21), taste disturbance (16;14),
weakness (16;11), arthralgia (15;24), headache (15;15), myalgia (15;25), dyspnea (14;16),
dyspepsia (14;8), nail disorder (14;15), anorexia (13;11), cough (13;22), pain in limb (13;13),
back pain (12;11), dizziness (12;8), lacrimation increase (12;7), paresthesia (12;16), sore
throat (12;11), appetite decrease (10;5), dehydration (10;7), bone pain (8;10), dermatitis
(8;11), insomnia (8;10), and peripheral neuropathy (6;10). Grade 3/4 adverse events (>5%) in
patients receiving XELODA plus docetaxel or docetaxel alone (%;%) were lymphocytopenia (89;84),
leukopenia (61;75), neutropenia/granulocytopenia (69;76), hand-foot syndrome (24;1),
stomatitis (18;5), neutropenic fever (16;21), diarrhea (15;6), anemia (10;6),
hyperbilirubinemia (9;4), nausea (7;2), alopecia (6;7), vomiting (5;2), asthenia (5;6),
and fatigue (4;6).
Contraindications and Warnings
- XELODA is contraindicated in patients who have a known hypersensitivity to
capecitabine or to any of its components or to 5-fluorouracil. XELODA is contraindicated
in patients with known dihydropyrimidine dehydrogenase (DPD) deficiency.
- XELODA is contraindicated in patients with severe renal impairment. Patients with
mild or moderate renal impairment at baseline should be carefully monitored for adverse
events. Patients with moderate renal impairment at baseline require a reduced starting dose.
- XELODA can induce diarrhea, sometimes severe. Patients with severe diarrhea should be
carefully monitored and given fluid and electrolyte replacement if they become dehydrated.
If an adverse event of grade 2, 3, or 4 occurs (eg, diarrhea), administration of XELODA
should be immediately interrupted until the adverse event resolves or decreases in
intensity to grade 1. Following a grade 2 reoccurrence of the adverse event or occurrence
of any other grade 3 or 4 adverse event, subsequent doses of XELODA should be decreased.
Please consult XELODA Prescribing Information (DOSAGE AND ADMINISTRATION) for recommended
dose modifications for management of adverse events.
- Women of childbearing potential should be advised to avoid becoming pregnant while
receiving treatment with XELODA. Men should use birth control while taking XELODA. Women
should not nurse when receiving XELODA therapy.
Precautions
- The addition of leucovorin to XELODA is not recommended. There was no apparent advantage in response rate by adding leucovorin to XELODA; however, toxicity was increased.
- Cardiotoxicity has been observed with XELODA, including myocardial infarction/ischemia, angina, dysrhythmias, cardiac arrest, cardiac failure, sudden death, electrocardiographic changes, and cardiomyopathy. These adverse events may be more common in patients with a prior history of coronary artery disease.
- Care should be exercised when XELODA is coadministered with CYP2C9 substrates.
- The level of phenytoin should be carefully monitored in patients taking XELODA and the dose of phenytoin may need to be reduced.
- If drug-related grade 2 to 4 elevations in bilirubin occur, administration of XELODA should be immediately interrupted until the hyperbilirubinemia resolves or decreases in intensity to grade 1.
Please see complete XELODA Prescribing Information.