Capecitabine adverse effects

Ixabepilone, a microtubule stabilizing agent, is indicated as monotherapy or in combination with capecitabine in MBC patients who have previously received an anthracycline and a taxane. Response rates and time to progression were increased with combination therapy as compared with capecitabine alone. Adverse effects include myelosuppression, peripheral neuropathy, and myalgias/arthralgias. 

Although not a taxane, ixabepilone is a novel microtubule inhibitor that was recently approved for metastatic breast cancer in combination with the oral fluoropyrimidine capecitabine or as monotherapy. It is a semisynthetic analog of epothilone B, and is active in the M phase of the cell cycle. This agent binds directly to 6-tubulin subunits on microtubules, leading to inhibition of normal microtubule dynamics. Of note, this agent continues to have activity in drug-resistant tumors that overexpress P-glycoprotein or tubulin mutations. The main adverse effects include myelosuppression, hypersensitivity reactions, and neurotoxicity in the form of peripheral sensory neuropathy. 

Generic Name Capecitabine Trade Name Xeloda Primary Antineoplastic lndication(s) Breast cancer Common Adverse Effects Blood disorders [anemia, neutropenia, thrombocytopenia] Gl distress [abdominal pain, nausea, vomiting] dermatitis stomatitis unusual tiredness... 

Her estimated creatinine clearance is 74 mL/min. This represents a relatively normal renal function, particularly for someone of Mrs RP s age. The Summary of Product Characteristics for capecitabine (Summary of Product Characteristics, 2008) states that the dosage only needs to be reduced if creatinine clearance is between 30 and 50 mL/min, to 75% dosage. If creatinine clearance is <30 mL/min, then capecitabine is contraindicated. This is because the incidence of severe adverse effects is more common in patients with renal impairment compared with the overall population. 

It is imperative for patients to manage the side-effects of oral chemotherapy appropriately. This includes knowing when to stop taking the tablets should severe adverse effects occur. There are clear recommendations for stopping capecitabine should certain specific side-effects occur whilst taking the drug and contacting the treatment centre for further advice. These include ... 

---