Treatment Name: Gemcitabine + Capecitabine (Xeloda®)
Gemcitabine + Capecitabine (Xeloda®) is a Chemotherapy Regimen for Pancreatic Cancer
How does gemcitabine + capecitabine work?
Each of the chemotherapy medications in gemcitabine + capecitabine are designed to kill or slow the growth of pancreatic cancer cells.
Goals of therapy:
Gemcitabine + capecitabine can be given after surgery to kill any pancreatic cancer cells that are still in the body. This chemotherapy treatment is commonly given with the goal of cure. It can also be given when the disease is metastatic (spread to other areas) where surgery is not usually done and treatment is to prolong life without a cure.
- Gemcitabine intravenous (I.V.) infusion over 30 minutes on Days 1, 8, and 15
- Usual capecitabine starting dose: 3 to 5 tablets (depending upon your height, weight, and kidney function) by mouth twice daily for 21 consecutive days, followed by 7 days off
Estimated total infusion time for this treatment:
- Up to one hour for Days 1, 8, and 15 of 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
Gemcitabine is usually given in an outpatient infusion center, allowing the person to go home afterwards. Capecitabine is taken at home and filled by an outpatient pharmacy from a doctor's prescription.
If the disease is not metastatic, gemcitabine + capecitabine is started within 12 weeks after surgery and is repeated every 28 days. This is known as one Cycle. Each cycle may be repeated up to six times, depending upon the stage of the disease. Duration of therapy may last up to six months, depending upon response, tolerability, and number of cycles prescribed.
If the disease is metastatic, gemcitabine + capecitabine is given until it no longer works or until unacceptable side effects occur. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.
Click here for the common gemcitabine + capecitabine starting doses.
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 gemcitabine + capecitabine side effects are shown here.
- Low white blood cell count [neutropenia] (87%)
- Fatigue (70%)
- Low red blood cell count [anemia] (58%)
- Diarrhea (50%)
- Blisters and peeling of skin on soles of feet and palms of hands (38%)
- Low platelets (31%)
- Fever (19%)
- Infection (13%)
- Blood clots (6%)
On average, 47% of patients discontinued treatment in the listed study before the sixth cycle due to unacceptable side effects.
How often is monitoring needed?
Labs (blood tests) may be checked before treatment then periodically during treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order. The CA19-9 (a tumor marker) is usually checked at the beginning of treatment and then about every six weeks thereafter to determine if the chemotherapy drugs are working.
How often is imaging needed?
Imaging may be checked before treatment then at the discretion of your doctor. Imaging may include: X-rays, 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 gemcitabine + capecitabine as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.
- Capecitabine may cause painful redness, blistering, and peeling skin reaction 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 while taking this drug
- Nausea and mouth sores from capecitabine may be more common in patients with kidney problems. Dose reductions may be necessary if your kidneys are not working well
- If an accidental overdose of capecitabine 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 pancreatic 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 Gemcitabine + Capecitabine (Xeloda®), 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 Gemcitabine + Capecitabine (Xeloda®). Depending upon your income, they may be able to help cover the cost of:
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 Gemcitabine + Capecitabine (Xeloda®) 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.
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 Gemcitabine + Capecitabine (Xeloda®)
What is Pancreatic Cancer?
A disease of the cells of the pancreas organ. There are different types of pancreatic cancer, the most common being pancreatic adenocarcinoma that accounts for about 85% of cases. This type affects the digestive enzymes produced by the pancreas. Risk factors include: smoking tobacco, obesity, diabetes, and some rare genetic conditions. It can spread to neighboring organs such as: liver, duodenum, stomach, colon, spleen, and kidneys.
Pancreatic cancer is treated with surgery, chemotherapy, radiation therapy, a combination of all these, or sometimes supportive care alone. Surgery can be curative, but it can also be used to reduce tumor size and improve quality of life. The stage can vary at diagnosis and throughout treatment. The Tumor, Node, Metastasis (TNM) staging system is used to stage pancreas cancer. Staging systems describe the extent of cancer throughout the body and help doctors determine which treatments to offer. 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, 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.
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.
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 status, 2) 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
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein
13) Serum glucose
14) Serum calcium
Common starting doses
- Gemcitabine 1000 mg/m2 intravenous (I.V.) infusion over 30 minutes on Days 1, 8, and 15
- Usual capecitabine starting dose: 830 mg/m2 (1660 mg/m2/day) by mouth twice daily for 21 consecutive days, followed by 7 days off
- Cycle is 28 days
Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability.
1. Neoptolemos JP, Palmer DH, Ghaneh P, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet 2017;389(10073):1011-1024.
2. Cunningham D, Chau I, Stocken DD, et al. Phase III randomized comparison of gemcitabine versus gemcitabine plus capecitabine in patients with advanced pancreatic cancer. J Clin Oncol 2009;27(33):5513-5518.