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Chemotherapy: CapeOx

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CapeOx is the common name for a combination of two different chemotherapy drugs:

When Capecitabine is broken down in the liver (metabolized), it turns into 5-FU (the main drug historically used with respect to colorectal cancer).

The amount of Xeloda and Oxaliplatin that you will receive depend on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated.  Your doctor will determine your dose and schedule. Following is standard information. If you print it and take it to the doctor, he or she can explain how treatment will be individualized for you and your situation.

Administration of CAPEOX

  • CAPEOX is given over a three week cycle ("cycle" is a medical term you are likely to hear which means the period of time between treatments. In the case of CAPEOX, this generally means that treatment is given every two weeks). 
  • Each CAPEOX treatment starts at a cancer center or doctor's office. 
  • CAPEOX medications are toxic and damage good cells as well as cancer cells. 
    • Toxicities from the drugs usually increase as the number of doses increases. 
    • Before the drugs are administered, medical staff will check blood levels, vital signs (such as body temperature, pulse, and blood pressure) and other indications such as side effects you experienced since the last infusion.   NOTE: Do not think you are helping yourself by not telling about all side effects you experience or their severity. Side effects may indicate a problem that only the medical team can assess. If a treatment is given when your body is not at the desired level, problems may result to the degree that you end up in the hospital. 
  • After the results are compiled (it usually takes 15-20 minutes to get the results of the blood work), you will meet with at least one member of your medical team.
    • This is the time to discuss coping with side effects and can be done about them going forward.
    • This is also the time to discuss any other matters that may  of concern to you.
  • A medical decision will be made whether to proceed with the planned treatment, whether the dosage of the Oxaliplatin needs to be varied, or whether the treatment needs to be postponed.
  • If the treatment goes forward, Oxaliplatin is delivered at the health care facility intraveneously through a needle in your arm (infused) over a period of two hours. The infusion generally also includes a steroid to prevent swelling and an anti-nausea medication to minimize nausea. 
    • The infusion may feel cold as it enters the vein. This feeling rarely lasts more than a few seconds.
  • Before leaving the facility, you will be given Capecitabine (Xeolda) in pill form to take twice a day for 14 days. Starting dose is usually 1000 mg/m2 twice daily. (Drugs should be stored in a dry, room temperature place out of the sunlight.) The pharmaceutical company which makes Capecitabine recommends that: 
    • The first dose should be taken in the morning within 30 minutes after finishing breakfast. 
    • The second dose is to be taken in the evening within 30 minutes after finishing dinner.
    • Then there is a 1-week rest period when you do not take Capecitabine.
    • Your morning dose may be different from your evening dose.
    • Always swallow XELODA tablets whole with water. Do NOT crush, chew or dissolve tablets.
    • If your doctor recommends a different schedule, follow the doctor's orders. 
    • It is important to take your pills every day, on schedule. For tips on how to keep to a schedule, click here. 
    • Store your drugs correctly. To learn how, click here.
    • Keep pills away from children and pets. (For more information on how to live with pills correctly, click here.)
    • When you travel, keep your supply of pills with you on the plane or train instead of with your luggage. Keep a copy of a prescription with you in case you are asked about the pills. For more information about travel tips while in treatment, click here. If you are going out of the country, click here

    Common side effects of CapeOx include the following. While there may be long lasting nerve damage, these side effects usually go away over time  For tips about coping with side effects, speak with your doctor. Also see the documents in “To Learn More.”

    • Abdominal pain
    • Blood levels
      • An increase in blood levels which suggest changes in liver function 
      • A decrease in white blood cells (anemia).
      • Either change can delay treatment.
      • Blood levels are checked weekly.
    • Diarrhea
    • Fatigue
    • Hand-foot syndrome which can include severe redness, swelling, tingling, numbness, pain or skin peeling and blistering of the hands or feet
    • Mouth sores or thrush (a fungal) throughout the digestive tract mouth to anus
    • Nausea/Vomiting
    • Numbness and tingling in hands and feet (Neuropathy)
    • Numbness of lips
    • Sensitivity in the hands and feet, particularly to hot and cold.

For rectal cancer, radiation is usually given in tandem with CapeOx. 

Toxicities from the drugs increase as the number of doses increases. Because of this, you will be monitored closely during each infusion of Oxaliplatin.

Toxicity from Oxaliplatin which affects the nerves (neurotoxicity) causes sensitivity in the hands and feet - especially to hot and cold.

  • The effect starts during infusion and can last for 5-14 days. It gradually gets better over time.
  • At its worst, your throat feels like it is closing when cold touches it and your hands feel like they are on fire when you touch anything cold.
  • It is helpful to keep a pair of gloves near the refrigerator so you can get what you need without touching something cold. 
  • Patients are cautioned not to eat ice chips or drink anything cold before, during, or for 5 days after getting the Oxaliplatin.

Side Effects From CAPEOX

There is no relationship between the presence or severity of side effects and the effectiveness of the medication. 

The higher the dosage used in the treatment, the more likelihood that side effects will appear.

Common side effects include the following:

  • Toxicity from Oxaliplatin affects the nerves (neurotoxicity) and causes sensitivity in the hands and feet - especially to hot and cold.
    • The effect starts during infusion and can last for 5-14 days. It gradually as each day passes after treatment.
    • The effect often shows up as one of the following:
      • Your throat feeling like it is closing when you eat or drink something cold  
      • When you touch something cold with your hands or feel, they feel like they are on fire or you get a painful shock.
    • Patients are cautioned not to eat ice chips or drink anything cold just before treatment, during treatment, or up to 5 days after getting Oxaliplatin.
    • Time tested tips for dealing with this side effect include keeping a pair of gloves near the refrigerator so you can get what you need without touching something cold. For additional tips, click here
  • Toxicity also causes blood level changes. For instance, an increase in elevated liver enzymes which suggest changes in liver function or a decrease in red blood cells (anemia) which decreases your body's infection fighting ability. (The lower the level, the more difficult it is for your body to fight infections.)
    • It is generally expected that blood levels will drop after an infusion. For some people it happens on day one. For others, the nadir (low point) is between day 7 and 10. In any event, blood levels usually recover before it is time for the next infusion.  
    • Blood levels are checked before each infusion. 
    • A change still existing on the day of an infusion can delay treatment. 
  • Fatigue usually starts some time within the first few weeks after the start of treatment. 
    • Fatigue gets cumulatively more intense and lasts for a while after the end of CAPEOX treatments. 
    • Even people who tolerate treatment well have a sense of fatigue. 
    • The person who has the same energy level at the end of a course of CAPEOX is the exception rather than the rule. 
    • For tips about dealing with fatigue, click here
  • Most patients experience feeling sick to the stomach (nausea) as a result of Oxaliplatin infusions. Nausea may also occur while taking the Captecitabine (Xeolda) pills, though the pills are generally more tolerable than the infusion. It takes longer for the drug to be distributed throughout the system which decreases the impact on the body .
    • An anti-nausea medication is generally included in the infusion to prevent or at least minimize nausea.
    • You are also likely to be given a prescription for anti-nausea medication. If you don't get one, ask for it.
    • Fill the prescription as soon as you get it, and carry the medications around with you. It is better to stop nausea as soon as it starts rather than wait to see if it evolves into vomiting. Vomiting can lead to dehydration and other medical problems. 
    • For information about dealing with nausea and vomiting, click here. 
  • Numbness and tingling in hands and feet (Neuropathy). 
    • One early sign of neuropathy in hands is difficulty buttoning your shirt.  Another is finding it difficult to hold objects and dropping things.
    • If neuropathy starts, the dosage of Oxaliplatin is generally reduced or even eliminated entirely because neuropathy can become permanent.  Neuropathy from Oxaliplatin is so common that experience at one nationally known NCI designated comprehensive center indicates that only a small percentage of people who complete a 6 month course of FOLFOX still receive Oxaliplatin at the end. This does not effect the ability to achieve the desired result (efficacy) of the treatment.
  • Diarrhea generally results at one time or another from taking Capecitabine pills.
    • Diarrhea can show up as a greater number of bowel movements a day than normal (for example, 4 extra movements). It could also show up as traditional watery diarrhea.
    • It is particularly important to keep diarrhea under control because it can lead to dehydration and other damage to the body. 
    • To learn techniques for controlling diarrhea, including foods to eat and foods to avoid, click here.
  • Mouth sores or thrush (a fungal) frequently occur due to taking Capecitabine orally.
    • For information about mouth sores and treating them, click here.
    • For information about thrush and treatment, click here.
  • Hand-foot syndrome frequently results from the Capecitabine (Xeolda). This can include severe redness, swelling, tingling, numbness, pain, tenderness or skin peeling and blistering of the hands or feet. In fact, hands can become so tender that touching anyt hing hurts. Feet can become so tender that it can feel as if you are walking on coals. Cracks or blisters can be a source of infection. To learn prevention techniques and techniques for dealing with hand-foot syndrome, click here

Other common side effects of CAPEOX include the following. While there may be long lasting nerve damage, these side effects usually go away over time  For tips about coping with side effects see the documents which are linked. In addition, speak with your doctor. 

Common side effects of CapeOx include the following. While there may be long lasting nerve damage, these side effects usually go away over time  For tips about coping with side effects, speak with your doctor. Also see the documents in “To Learn More.”

  • Abdominal pain
  • Blood levels
    • An increase in blood levels which suggest changes in liver function 
    • A decrease in white blood cells (anemia).
    • Either change can delay treatment.
    • Blood levels are checked weekly.
  • Diarrhea
  • Fatigue
  • Hand-foot syndrome which can include severe redness, swelling, tingling, numbness, pain or skin peeling and blistering of the hands or feet
  • Mouth sores or thrush (a fungal) throughout the digestive tract mouth to anus
  • Nausea/Vomiting
  • Numbness and tingling in hands and feet (Neuropathy)
  • Numbness of lips
  • Sensitivity in the hands and feet, particularly to hot and cold.

While there may be long lasting nerve damage, these side effects usually go away over time.

A rare side effect is mental impairment known as Chemo Brain. For information about ChemoBrain, click here

When To Stop Taking Capecitine (Xeloda)

According to the manufacturer: Stop taking XELODA immediately and contact your doctor right away if you have any of these serious common side effects or any other side effects that worry you:

  • Diarrhea — at least 4 more bowel movements each day than is normal for you or if you wake up because you need to have a bowel movement
  • Throwing up (vomiting) — more than once in 24 hours
  • Feeling sick to your stomach (nausea) — if you don't feel like eating and if the amount of food you eat each day is much less than usual
  • Pain, redness, swelling, or sores in your mouth (stomatitis)
  • Hand-and-foot syndrome — pain, swelling, or redness of your hands or feet that prevents normal activity
  • Fever or infection — a temperature of 100.5°F or higher or other signs of infection

NOTE:

  • For rectal cancer, radiation is usually given in tandem with CAPEOX.  The combination is known as ChemoRadiation. For information about ChemoRadiation, click here.
  • Keep track of your symptoms with our Symptoms Diary. With the click of a button, the diary is turned into an easy-to-read graph which will save the medical team time which you can use to ask questions of concern.
  • If you are taking blood thinners, be sure your doctor know. Capecitibine may increase the effect of this medicine. This could lead to serious side effects. Be sure to let your cancer doctor know you are taking blood thinners, and the doctor who prescribed the blood thinners that you are taking Capecitine (Xeloda).
  • If you have additional questions about Capecitibine, ask your doctor or his/her nurse - or contact nurses that Genentech BioOncology makes available to patients at 877.987.2487

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