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Treatment Name: Capecitabine (Xeloda®) + Oxaliplatin

Capecitabine (Xeloda®) + Oxaliplatin is a Chemotherapy Regimen for Colon Cancer

Other names for this treatment:
XELOX or XelOx (pronounced "zell-ox")
CAPOX or CapOx or CapeOx (pronounced "cape-ox")

How does capecitabine + oxaliplatin (CapOx) work?
These drugs are designed to slow the growth and kill colon cancer by damaging the DNA of these rapidly dividing cells.

Goals of therapy:
Capecitabine + oxaliplatin can be given to shrink tumors and decrease symptoms of colon cancer. If colon cancer is early stage (limited to intestine tissue or surrounding lymph nodes), it is commonly given with the goal of cure.

If colon cancer is advanced or metastatic (spread to other areas of the body), capecitabine + oxaliplatin is not commonly given with the goal of cure, but rather to shrink tumors and decrease symptoms.

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Schedule

  • Capecitabine usual starting dose: 3 to 5 tablets by mouth twice daily (depending upon your height, weight, and kidney function) for 14 days of a 21-day cycle 
  • Oxaliplatin intravenous (I.V.) infusion over two hours on Day 1 of a 21-day cycle

Estimated total infusion time for this treatment:

  • Up to 3 hours each cycle
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time

Oxaliplatin is usually given in an outpatient infusion center, allowing the person to go home afterwards.

Capecitabine is usually taken at home TWICE daily for 14 days then is NOT taken for 7 days. Several tablets are often taken for each dose to equal the total amount prescribed.

Capecitabine + oxaliplatin has a 21-day Cycle, which may be repeated up to 8 times. If the disease is not metastatic then duration of therapy may last up to six months depending upon response, tolerability, and number of cycles prescribed. If the disease is metastatic, capecitabine + oxaliplatin can be continued until it no longer works or until unacceptable side effects are seen.

Click here for common starting doses.

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Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported drug side effects with CapOx (capecitabine + oxaliplatin) are shown here. Side effects sometimes have percentage ranges [example: 62 – 66% have nausea] because they differed between clinical studies:

  • Nerve pain or tingling in fingers or toes (57 - 78%)
  • Nausea (62 - 66%)
  • Diarrhea (60 - 65%)
  • Vomiting (43%)
  • Fatigue (35 - 37%)
  • Skin reaction on the palms of hands and soles of feet (29 - 30%)
  • Low white blood cells [neutropenia] (26 - 27%)
  • Loss of appetite (24 - 27%)
  • Abdominal pain (17 - 26%)
  • Constipation (23%)
  • Mouth sores (21 - 22%)
  • Increased bleeding risk [low platelets] (20%)
  • Weakness (19%)
  • Fever (18%)
  • Hair loss (4%)

The actual percentage of patients experiencing nausea or vomiting may be less than reported above as newer, more effective medications for nausea and vomiting have become available since this clinical study was conducted.

Compared to patients receiving Fluorouracil (5-FU) + Leucovorin + Oxaliplatin, patients receiving Capecitabine + Oxaliplatin experienced less diarrhea and hair loss, but more vomiting and skin reactions on the palms of hands and soles of feet.

Approximately 22 - 26% of patients discontinue Capecitabine + Oxaliplatin due to unacceptable side effects.

Side effect videos Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaPainPainFatigue Fatigue Neutropenic FeverNeutropenic FeverConstipationConstipationBleedingBleedingHair LossHair Loss

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Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before each treatment, then periodically during treatment until stable. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), serum calcium, serum magnesium, plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment, periodically during treatment, and at the end of treatment. Imaging may include: X-rays, electrocardiogram (ECG or "EKG"), magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue capecitabine + oxaliplatin as planned, or delay or switch therapy.

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ChemoExperts Tips

  • Oxaliplatin can make you very sensitive to cold things such as cold drinks or cold weather for a few days after receiving it. It is best to wear warm clothes in cold weather and to not drink cold liquids, especially those with ice, or hold cold objects in your hands for up to two days after each infusion
  • Capecitabine may cause painful redness, blistering, and peeling skin reactions on the palms of your hands and on the soles of your feet. This is known as Hand-Foot Syndrome. Ways to help reduce the risk of experiencing Hand-Foot Syndrome include using a non-alcoholic moisturizer daily on your hands and feet, avoid wearing gloves, avoid prolonged exposure to hot water, and avoid activities that put pressure or friction on your hands and feet such as golf or tennis
  • Nausea and mouth sores may be more common with capecitabine in patients with kidney problems. Dose reductions may be necessary if your kidneys are not working well
  • If an accidental overdose of capecitabine (Xeloda®) occurs, contact your doctor and go to the emergency room immediately. In severe cases, an antidote called uridine triacetate (Vistogard®) may be given to protect healthy cells and decrease side effects
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for colon cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Capecitabine (Xeloda®) + Oxaliplatin, we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Capecitabine (Xeloda®) + Oxaliplatin. Depending upon your income, they may be able to help cover the cost of:

  • Capecit­abine
  • Oxaliplatin

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Capecitabine (Xeloda®) + Oxaliplatin and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Capecitabine (Xeloda®) + Oxaliplatin

Individual Drug Label Information

Capecit­abine (Xeloda®)

  • Capecitabine Is an oral tablet with two strengths: 150 mg and 500 mg tablets
  • Swallow tablets whole with water.  Take within 30 minutes after eating a meal
  • A dose may combine both tablet strengths and multiple tablets of each (see manufacturer’s package insert for dose/tablet calculation table)
  • Doses are usually divided; taken twice daily, 12 hours apart
  • There is a strong drug interaction with certain blood thinner medications (anticoagulants) like warfarin (Coumadin) that can increase bleeding.  Doses of both capecitabine and the anticoagulants may have to be adjusted.  Immediately report any bleeding  while on capecitabine
  • There are drug interactions with phenytoin (Dilantin) and leucovorin.  Ask your doctor or pharmacist to review your medications before starting capecitabine
  • May cause fetal harm, avoid this drug during pregnancy
General Capecitabine (Xeloda) Side Effects
  • Diarrhea
  • Nausea and vomiting
  • Abdominal pain
  • Heart problems
  • Fatigue
  • Dehydration and kidney failure
  • Mouth sores (stomatitis)
  • Constipation
  • Hand-foot syndrome. Treat with a non-alcoholic moisturizer
  • Dry skin
  • Eye irritation
  • Nerve pain, tingling sensation in fingers and toes
  • Lack of appetite (anorexia)
  • Bleeding
  • Liver toxicity. Baseline and regular blood tests are necessary
  • Age greater than 60 years is associated with a higher incidence of all side effects
  • Click on the capecitabine (Xeloda) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue BleedingBleedingConstipationConstipationPainPainAnemiaAnemiaNeutropenic FeverNeutropenic FeverBlood ClotsBlood Clots

See DailyMed package insert.

Oxaliplatin (Eloxatin®)

  • Oxaliplatin is an intravenous (I.V.) drug
  • Allergic reactions have been reported and may occur within minutes. Certain drugs can be given to alleviate the symptoms: antihistamines, corticosteroids, or epinephrine
  • Oxaliplatin is usually diluted in a dextrose 5% I.V. bag and infused over 2 hours
  • Dosage adjustments may be required for liver dysfunction
General Oxaliplatin (Eloxatin) Side Effects
  • Nerve pain or tingling in feet and hands, loss of tendon reflexes
  • Oxaliplatin can make you very sensitive to cold things such as cold drinks or cold weather for a few days after receiving oxaliplatin. It is best to wear warm clothes in cold weather and to not drink cold liquids, especially those with ice, or hold cold objects in your hands for up to 2 days after each oxaliplatin infusion
  • Lung toxicity:  avoid with certain lung conditions
  • Low white blood cells, platelets, and red blood cells
  • Constipation
  • Diarrhea
  • Vomiting or nausea
  • Fatigue
  • Mouth sores
  • Change in liver function
  • Avoid during pregnancy, known to cause fetal harm
  • Click on the oxaliplatin (Eloxatin) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue ConstipationConstipationPainPain

See DailyMed package insert.

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References

1) Schmoll HJ, Cartwright T, Tabernero J, et al. Phase III trial of capecitabine plus oxaliplatin as adjuvant therapy for stage III colon cancer: a planned safety analysis in 1,864 Patients. J Clin Oncol. 2007;25:102-109.

2) Cassidy J, Clarke S, Díaz-Rubio E, et al. Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer. J Clin Oncol. 2008;26:2006-2012.

Created: March 27, 2016 Updated: October 3, 2018

What is Colon Cancer?

A disease of the cells from the large intestine.  Colon cancer is the third most common cancer among both men and women.  Known causes include:  family history, poor diet, sedentary lifestyle, obestity, diabetes, history of colon polyps, smoking, heavy alcohol use, prior radiation treatment to abdomen for other cancers, and old age.  The stage can vary at diagnosis and throughout treatment.  Stages of colon cancer use Tumor, Node, Metastasis (TNM) staging as well as Stage Grouping using Stages I, II, III, or IV.  The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What does "Cure" mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, doctors use the word “remission” is used more often. This means there are no signs or symptoms of cancer.

Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back. Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

Clinical Studies

If you are interested in reading the clinical trials results, please click on reference below:

1) Schmoll HJ, Cartwright T, Tabernero J, et al. Phase III trial of capecitabine plus oxaliplatin as adjuvant therapy for stage III colon cancer: a planned safety analysis in 1,864 Patients. J Clin Oncol. 2007;25:102-109.

2) Cassidy J, Clarke S, Díaz-Rubio E, et al. Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer. J Clin Oncol. 2008;26:2006-2012.

Common Starting Doses

  • Capecitabine ranges between 850 - 1000 mg/m2 by mouth twice daily for 14 days of a 21-day cycle (the last seven days, off drug)
  • Oxaliplatin 130 mg/m2 intravenous (I.V.) infusion over 2 hours on Day 1 of a 21-day cycle

Note: Individual doses may vary based upon your Doctor's recommendation, drug availability, height, weight, and kidney function.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium