Oxaliplatin and capecitabine (Xeloda®) chemotherapy
This information is about a chemotherapy treatment called oxaliplatin and capecitabine that is used for bowel cancer that has spread (advanced).
It is sometimes used to shrink a cancer that has spread to the liver (secondary liver tumours) so that they can be removed by surgery.
You will see your doctor regularly while you have this treatment so they can monitor the effects of the chemotherapy.
The drugs that are used
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The treatment involves the chemotherapy drugs:
How treatment is given
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Oxaliplatin and capecitabine treatment can usually be given to you as a day patient. Before starting treatment you will need to have a blood test, either on the same day or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.
The nurse will put a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful, but it shouldn’t take long. Some people have their chemotherapy given through a fine plastic tube that is inserted under the skin and into a vein near their collarbone (central line), or passed through a vein in the crook of their arm (PICC line). Your doctor or nurse will explain more about this to you.
Before the chemotherapy you will be given some anti-sickness (anti-emetic) drugs. These are usually given by injection through the cannula, central line or PICC line, which is connected to a drip (infusion). Some anti-sickness medicines are given as tablets.
The chemotherapy drugs are then given separately. Oxaliplatin (a colourless fluid) is given as an infusion that lasts about two hours. You will then be given your capecitabine tablets to take at home.
Capecitabine is given as tablets to take twice a day. The tablets should be swallowed whole with a glass of water. They should be taken within half an hour of finishing a meal, as capecitabine works best if it's broken down in the stomach with food. You should take them in the morning just after breakfast and then again just after your evening meal so that the doses are spaced at least eight hours apart.
If you have trouble swallowing capecitabine tablets, they can be dissolved in a 200ml glass of warm water. The mixture should be stirred with a spoon until the tablets are completely dissolved and then drunk immediately. You can add some blackcurrant juice just before swallowing to help disguise the taste. The glass and spoon should be washed and kept separate from your other crockery and cooking utensils.
Capecitabine tablets are available as 500mg peach-coloured tablets, and 150mg light-peach coloured tablets. Your doctor may want you to take a combination of 500mg and 150mg tablets, depending on the dose you need. It is important to take the tablets as directed by your doctor, specialist nurse or pharmacist.
If you are having your treatment as a day patient, you can go home when it is finished. The cannula will be removed before you go. If you have a central or PICC line it will usually stay in place, ready for the next cycle of your chemotherapy. You will be shown how to look after the line.
You will be given a supply of anti-sickness tablets to take home with you. It is important to take these as directed, even if you aren't feeling sick, as some anti-sickness drugs are much better at preventing sickness than stopping it once it starts.
How often treatment is given
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Your doctor may use the word ‘regimen’ (eg XELOX or CAPOX regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular chemotherapy treatment that you are receiving.
On the first day of treatment you'll be given a drip (infusion) of oxaliplatin. You'll also take your first dose of capecitabine tablets on the same day in the evening. You will continue to take the capecitabine tablets twice daily, once in the morning and once evening, for 14 days.
When you finish your capecitabine tablets you will have a rest period with no chemotherapy for the next seven days. This completes a cycle of your chemotherapy. Each cycle lasts 21 days (three weeks).
You will start the next cycle of your treatment after the rest period, which will be 21 days (three weeks) after your first infusion of oxaliplatin. The treatment is usually given for 4-8 cycles over a period of 3-9 months. This makes up a course of treatment.
Occasionally, oxaliplatin may be given more frequently than every three weeks and the capecitabine tablets may be given over one week rather than two. Your doctors and nurses will give you specific information about your treatment.
Each person's reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone who has this treatment.
We have outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you.
If you notice any effects that are not listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
Oxaliplatin and capecitabine chemotherapy can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you will be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment and your resistance to infection is usually at its lowest 10-14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel unwell, even with a normal temperature.
You will have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
Bruising or bleeding
Oxaliplatin and capecitabine can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
Oxaliplatin and capecitabine can reduce the number of red blood cells, which carry oxygen around the body. A low red cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Numbness or tingling in hands or feet
Oxaliplatin can have an effect on the nerve endings, which is known as peripheral neuropathy. This may result in feelings of numbness or tingling, especially in the hands or feet. You may also notice that you have difficulty doing up buttons or similar fiddly tasks.
For some people, these symptoms can be triggered by anything cold, such as iced drinks and cold air. If you notice that your symptoms are related to the cold, you should avoid cold drinks and wrap up warmly in the cold weather. It is important to report your symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug.
Sometimes the tingling or numbness may not happen with the first treatment, but after several treatments. This is known as a 'cumulative effect’ and should improve after the treatment has finished. However, for some people, the tingling and numbness can last for several months or persist. Tell your doctor if this is the case for you.
Feeling sick (nausea) or being sick (vomiting)
This may begin soon after the treatment is given and can last for a few days. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Capecitabine can cause a rash or dry skin, which may be itchy. Your doctor can prescribe medicine to help with this.
Soreness and redness of the palms of hands and soles of feet
This is sometimes known as palmar plantar or hand-foot syndrome. It can happen when capecitabine and oxaliplatin is given. It is usually temporary and improves when the treatment is finished.
Your doctor may prescribe creams or a vitamin called pyridoxine (vitamin B6), which some people find helpful. It can also help to keep your hands and feet cool and to avoid tight fitting clothing, such as socks, shoes and gloves.
During treatment with capecitabine and for several months afterwards, you will be more sensitive to the sun, and your skin may burn more easily than normal. You can still go out in the sun, but should wear a suncream with a high sun protection factor (SPF) and cover up with clothing and a hat. You might find our page on taking care in the sun useful.
Feeling tired is a common side effect of chemotherapy especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections. You may find our section on mouth care during chemotherapy helpful.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Oxaliplatin and capecitabine can cause diarrhoea. This can be quite severe, but can usually be controlled with medicines. It is important to drink plenty of fluids, and you may be given medicine to take. Follow the instructions and take it immediately. If you have diarrhoea more than 4-6 times a day, or if you have it at night, contact your specialist for advice immediately. You may be advised to stop taking capecitabine. However, once the diarrhoea has eased your doctor will tell you if you can restart the treatment, perhaps at a lower dose.
Oxaliplatin and capecitabine may cause an inflammation of the lining of the eyelids (conjunctiva) that makes your eyes feel sore, red and itchy. Let your doctor know so they can prescribe soothing eye drops if necessary.
Less common side effects
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Oxaliplatin can affect the area around the voice box (larynx), causing a sensation of difficulty swallowing and severe breathing difficulties. This symptom may be made worse by cold temperatures, so it’s advisable to avoid cold drinks and ice cubes for a few days after treatment. You might find our section on breathing more easily useful.
This side effect can be very frightening although it should only be temporary. If you have breathing difficulties, take long deep breaths through your nose. This will have a calming effect and help your breathing return to normal.
It’s important to let your doctor know if you have this side effect. Your doctor may increase the time of your oxaliplatin infusion to 4-6 hours in future cycles to reduce the chance of this happening.
Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, reddening of the face, dizziness, a headache, breathlessness, anxiety, and a feeling that you want to pass urine. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse about any side effects you have.
This is rare, but your hair may thin or occasionally fall out completely. If this happens, it usually begins about 3-4 weeks after starting treatment, although it may occur earlier. This is temporary and your hair will start to grow back once the treatment has finished. Your hair may grow back straighter, curlier, finer or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss.
Some people find that oxaliplatin and capecitabine causes headaches. Let your doctor or nurse know. They can give you painkillers to relieve this.
Some people may feel dizzy or light headed. Tell your doctor if you have any of these side effects.
Changes in the way your heart works
Capecitabine may affect the way your heart works. Some people can experience chest pain and tightening across the centre of the chest while taking it. Chest pain can be caused by many different things other than chemotherapy. If you develop any of these symptoms, contact your doctor immediately.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Capecitabine interacts with the drugs phenytoin (Epanutin®), allopurinol (Zyloric®) and interferon alpha (IntronA®, Roferon-A®). It may also affect the action of some medicines given to thin the blood (anti-coagulants) such as warfarin. Let your doctor know if you are taking any of these.
You should also tell your doctor if you’re taking folic acid because it might increase the side effects of capecitabine.
Some other medicines, including those you can buy in a shop or chemist, can be harmful to take when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
It's not advisable to become pregnant or father a child while having oxaliplatin and capecitabine chemotherapy, as it may harm the developing baby. It’s important to use effective contraception while taking/having this drug, and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
Loss of periods in women
Because of the effect of chemotherapy on the ovaries, women may find that their periods become irregular and they may eventually stop. In some women this may be temporary, but for others it will be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.
There is a potential risk that chemotherapy drugs may be present in breast milk so women are advised not to breastfeed during chemotherapy and for a few months afterwards.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based on our oxaliplatin and capecitabine fact sheet, which has been compiled using information from a number of reliable sources including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Perry MC. The Chemotherapy Source Book. 4th edition. 2007 Lippincott Williams and Wilkins.
Cassidy J, et al. Randomised phase III study of Capecitabine plus Oxaliplatin compared with Fluorouracil/Folinic Acid plus Oxaliplatin as first line therapy for metastatic colorectal cancer. Journal of Clinical Oncology. 2008. 26, (12): 2006–2012.