Xeloda vs. 5FU

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Caat55
Posts: 545
Joined: Sat Dec 23, 2017 6:01 pm

Xeloda vs. 5FU

Postby Caat55 » Wed Feb 21, 2018 3:01 pm

I am having mop up chemo now I have to decide which drug to partner with oxiplatin.
I am a pediatric occupational therapist. Work with my hands, sometimes on floor, sometimes tabletop.
What are your thoughts? I want to continue working if possible during treatment.
Susan
55 y.o. Female
Dx 9/26/17 RC Stage 3
Completed 33 rad. tx, xeolda 12/8/17
MRI and PET 1/18 sign. regression
Surgery 1/31/18 Ileostomy, clean margins, no lymph node involved
Port 3/1/2018
Oxaliplatin and Xeloda start 3/22/18
Last Oxaliplatin 7/5/18, 5 rounds
CT NED 9/2018

Eleda
Posts: 197
Joined: Thu Dec 28, 2017 2:28 am
Facebook Username: adele Morgan
Location: Ireland

Re: Xeloda vs. 5FU

Postby Eleda » Wed Feb 21, 2018 4:53 pm

From what I gather its rhe oxiliplatin its the culprit
susan
Im suprised the adjuvant chemo is so severe!!!!
How long will u have to do it???
Im following ur progress as im.only trotting behind
Sorry im actually of no help to u on thos one
Xeloda did nothing to me tbh but was only on low dose
1650mg 2xday
Good luck with ur decision
ADELE X
SWF, 47
Mom to 3 sons 6/8/12
Dec4th 2017 colonoscopy for minor intermittent rectal bleeding during Summer
CEA 4.4
DX T3 L3C M0 2.5/3 cm above AV.
JAN 3RD started 1650mg Zelda 2xday, with 28 radiation
Did tagamet 800mg daily and 75mg IV VIT C WEEKLY UNTIL SURGERY and
Tumor reduce by 80% 1 LN still remaining
TATME May10th, temp illeostomy
10/07/2018 CEA 3
MMR INTACT
Began FOLFOX July 10th
24/08/2018 Allergic reaction so next infusion lucovorin and 5fu
CEA 4
Second attempt with oxi aug 12th

heiders33
Posts: 313
Joined: Sat Nov 04, 2017 11:08 am

Re: Xeloda vs. 5FU

Postby heiders33 » Wed Feb 21, 2018 5:17 pm

My understanding is that there are two differences between Xeloda and 5FU: 1) Xeloda has more GI effects 2) 5FU gets more quickly into your bloodstream. The advantage of Xeloda is that it’s pills over a pump. My onc said he didn’t see much difference in outcomes between the two, at least in my case. I went with the pills because I had a good response with them during neo-adjuvant. I’ve had very few side effects with Xeloda except a little diahrrea and irritated feet, which may also be the Oxi. What does your onc recommend in your case?
36 year-old female
May 2017: Dx rectal cancer at T3N2M0
MSS, KRAS G12A
June-July 2017: 28 days of XEL/radiation
Sep 2017: laparoscopic LAR/loop ileostomy
Oct 2017 - February 2018: XELOX six rounds
Mar 2018: reversal
Apr 2018: CEA 2.1, normal blood counts
May 2018: CT liver spot
Aug 2018: Abnormal PET, CEA 2.4
Sep 2018: robotic and laparoscopic liver resection with HAI pump
Oct 2018: Clear CT and colonoscopy, CEA 1.7, begin six months FUDR and FOLFIRI

Eleda
Posts: 197
Joined: Thu Dec 28, 2017 2:28 am
Facebook Username: adele Morgan
Location: Ireland

Re: Xeloda vs. 5FU

Postby Eleda » Wed Feb 21, 2018 5:45 pm

Think Xeloda converts to 5 FU in the body so much of the muchness ( Z has less side effects ) from.what ive read
I only finished cheno/radiation LAST fri week so haven't spoken to my oncology yet

I asked him abo new,trials at x mas and said he had nothing for me now
But will have on the other side( ie after surgery) but didnt specify ( prob need pathology to decide)
New studys show 3 months as effective as 6 if thats any help ( less long term side effects )
Today is my first day bladder pain free yaaahhhyyy!!! Lol
Im clearly excited lol
ADELE
SWF, 47
Mom to 3 sons 6/8/12
Dec4th 2017 colonoscopy for minor intermittent rectal bleeding during Summer
CEA 4.4
DX T3 L3C M0 2.5/3 cm above AV.
JAN 3RD started 1650mg Zelda 2xday, with 28 radiation
Did tagamet 800mg daily and 75mg IV VIT C WEEKLY UNTIL SURGERY and
Tumor reduce by 80% 1 LN still remaining
TATME May10th, temp illeostomy
10/07/2018 CEA 3
MMR INTACT
Began FOLFOX July 10th
24/08/2018 Allergic reaction so next infusion lucovorin and 5fu
CEA 4
Second attempt with oxi aug 12th

Beckster
Posts: 289
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Xeloda vs. 5FU

Postby Beckster » Wed Feb 21, 2018 6:09 pm

I took 3000mg of Xeloda a day for 6 months. By the 3rd cycle, I had hand foot syndrome and my onc had to lower the dose. If you develop this on Xeloda, it might be difficult to do your job.
57/Female
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size: 3.5 cm x 2.5 x 0.7 cm
Grade: G3 (surgical) G2 (pre-op)
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic reaction to oxaliplatin on first infusion-discontinued
1/2/17 to 6/9/17- Xeloda monotherapy
6/26/17, 12/12/17, 6/18/18 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5
Clear Colonoscopy 10/17 :D

mhf1986
Posts: 158
Joined: Sat Mar 11, 2017 8:30 pm
Location: near DC

Re: Xeloda vs. 5FU

Postby mhf1986 » Wed Feb 21, 2018 6:24 pm

DH did 5FU for 12 months and switched to Xeloda. He was on 3000mg a day. Diarrhea for most of the time, peeling hands and feet. Bilirubin went up so the onc delayed treatment for 7 weeks. He has now switched back. Yes, it was nice not carrying around the pump and it was nice going every 3 weeks (for the 3 treatments it lasted) but the side effects were too much.

Each person will react differently!

M
Caregiver to DH, dx @ 50, mets to liver/lungs, MSS, wild
9/16 CEA 114, blockage, left hemi, perm. colostomy
11/16 port in, FOLFOX + Avastin
6/17 CEA 15, 5FU + A only due to neuropathy
11/17 CEA 38, CAPOX + A
1/18 CAPOX = hi bilirubin/bad hfs, back to FOLFOX + A
5/18 growth; Vectibex + 75% Irinotecan
7/18 CEA 23, shrinkage
10/18 CEA 28, growth of 2 liver tumors/shrinkage of few and lung nodes
11/18 Lonsurf, looking at spheres, proton, trials
11/19/18 Peace

Caat55
Posts: 545
Joined: Sat Dec 23, 2017 6:01 pm

Re: Xeloda vs. 5FU

Postby Caat55 » Wed Feb 21, 2018 7:02 pm

mhf1986 wrote:DH did 5FU for 12 months and switched to Xeloda. He was on 3000mg a day. Diarrhea for most of the time, peeling hands and feet. Bilirubin went up so the onc delayed treatment for 7 weeks. He has now switched back. Yes, it was nice not carrying around the pump and it was nice going every 3 weeks (for the 3 treatments it lasted) but the side effects were too much.

Each person will react differently!

M



So side effects were worse with Xeloda? Oncologist said the dosage I would take this round is much higher than with the radiation.

Susan
55 y.o. Female
Dx 9/26/17 RC Stage 3
Completed 33 rad. tx, xeolda 12/8/17
MRI and PET 1/18 sign. regression
Surgery 1/31/18 Ileostomy, clean margins, no lymph node involved
Port 3/1/2018
Oxaliplatin and Xeloda start 3/22/18
Last Oxaliplatin 7/5/18, 5 rounds
CT NED 9/2018

Caat55
Posts: 545
Joined: Sat Dec 23, 2017 6:01 pm

Re: Xeloda vs. 5FU

Postby Caat55 » Wed Feb 21, 2018 7:08 pm

heiders33 wrote:My understanding is that there are two differences between Xeloda and 5FU: 1) Xeloda has more GI effects 2) 5FU gets more quickly into your bloodstream. The advantage of Xeloda is that it’s pills over a pump. My onc said he didn’t see much difference in outcomes between the two, at least in my case. I went with the pills because I had a good response with them during neo-adjuvant. I’ve had very few side effects with Xeloda except a little diahrrea and irritated feet, which may also be the Oxi. What does your onc recommend in your case?


Thanks for sharing your experience. Did you have any issues with the pills during neoadjunct?
The oncologist says there are fewer side effects from the 5 FU. I have water logged feet and dry hands with Xeloda from before, honestly a nuisance but not debilitating. But this is a much bigger dose. I had a great response to treatment prior to surgery. I have to let him know tomorrow.

Susan
55 y.o. Female
Dx 9/26/17 RC Stage 3
Completed 33 rad. tx, xeolda 12/8/17
MRI and PET 1/18 sign. regression
Surgery 1/31/18 Ileostomy, clean margins, no lymph node involved
Port 3/1/2018
Oxaliplatin and Xeloda start 3/22/18
Last Oxaliplatin 7/5/18, 5 rounds
CT NED 9/2018

User avatar
juliej
Posts: 2878
Joined: Thu Aug 05, 2010 12:59 pm

Re: Xeloda vs. 5FU

Postby juliej » Wed Feb 21, 2018 7:33 pm

Xeloda causes hand-foot syndrome (HFS) in 45-56% of patients. Studies show that most patients have their first episode of HFS within the first two cycles. I know that was the case with me. By the second cycle my hands and feet were turning red and burning. However, in the study, 89% of the HFS episodes were grade 1 or 2. Only 11% were grade 3. I was one of the grade 3's. I lost 3 toenails, had bleeding toes, and very painful hands.

So... you could take Xeloda for one or two cycles and see if you were in the 11% group that has light side-effects. Then switch to the pump if necessary at that point. Or you could hedge your bet and just start with the pump at the beginning.

I'm a little more concerned about the oxaliplatin. It causes oxaliplatin-induced peripheral neuropathy (OIPN), which could be very detrimental in your line of work.

Here is the finding from the most recent (J Clin Neurol. 2018 Jan; 14(1): 81–89.) longitudinal study of OIPN:

This longitudinal study found that chronic OIPN was present in 94% and 64% of colon cancer patients at the end of oxaliplatin treatment and 1 year after treatment, respectively. The main clinical characteristics of cumulative OIPN were distal numbness and tingling in the fingers and hands/toes and feet, and these symptoms tended to worsen as the cumulative dose of oxaliplatin increased during the 12 FOLFOX treatment cycles. Grade-3 neuropathy was identified in 0, 3, and 14% of patients after 4, 8, and 12 cycles of treatment, respectively. These results are consistent with previous studies finding chemotherapy-induced neuropathy in 80–92% of the patients who were treated with the FOLFOX regimen, in which 8–15% of the neuropathies were grade 3.

I think it's very important to monitor your hands after the oxaliplatin infusions and report any issues to your onc. The dose can be lowered or the number of cycles reduced if you're among those who experience higher grade neuropathy. Because of your line of work, you might see if you can get regular assessments of your sensory nerves to see how things are progressing. Some patients (half of all patients in the study) make it though all 12 treatment cycles and only experience grade 1 neuropathy so you might be one of the lucky ones.

So my advice is
Option 1: Try Xeloda for one or two cycles and see if you start getting HFS. If so, discontinue and switch to 5FU pump.
Option 2: Start with 5FU pump so there's no risk of HFS, but there will be some inconvenience and different side-effects.
In either case, talk to your onc about your profession and ask them to monitor any neuropathy from the oxaliplatin.

Hope this helps!
Juliej
Stage IV, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/11
LAR, liver resec, HAI pump 11/11
Double lung surgery + ileo reversal 2/12
Adjuvant Xeloda 3-9/12
VATS rt. lung 12/21/12 - benign granuloma!
NED 3/17/12 to 9/14/2018, CEA<1

mozart13
Posts: 140
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

Re: Xeloda vs. 5FU

Postby mozart13 » Wed Feb 21, 2018 8:05 pm

For the purpose of working during chemo, pump for 2 days might be interfiring with daily abilities to perform the job. You will need pic line or port. PIC lines sometimes get infected, about 40%.
I had redness around pic line, managed to resolve it with some heavy duty antibiotic cream.

The question here is :Will it make any difference in the long run, pills or infusion?

Your immune system will be deprived, very easy to pick up infection.
I stopped working at the begining of my chemo, could have worked till about 2nd round on my week off, but the system is not designed to have week off, so I opted for LTD, still on it beceause of neuropthy.

Working will probablly make you feel good.

Good luck!
55 year at the time of diagnosis, male
Diagnosed with T1,T2 N0 M0 rectal cancer
Total neoadjuvant therapy or TNT (chemoradiation followed by systemic chemotherapy)
Negative since Feb. '17
No surgery
Watch&Wait approach 8)
I don’t come much to forum , so if this is not updated it means I remain negative!
Wish good luck to all!

NHMike
Posts: 1838
Joined: Fri Jul 21, 2017 3:43 am

Re: Xeloda vs. 5FU

Postby NHMike » Wed Feb 21, 2018 8:14 pm

I try to stay away from kids when I'm on chemo. I don't think that they're allowed in the cancer center at the local hospital (it's a separate area from the general hospital) unless they have a reason to be there (treatment).
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 9/8: 1.8; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal

Caat55
Posts: 545
Joined: Sat Dec 23, 2017 6:01 pm

Re: Xeloda vs. 5FU

Postby Caat55 » Wed Feb 21, 2018 8:16 pm

[quote="mozart13"]For the purpose of working during chemo, pump for 2 days might be interfiring with daily abilities to perform the job. You will need pic line or port. PIC lines sometimes get infected, about 40%.
I had redness around pic line, managed to resolve it with some heavy duty antibiotic cream.

The question here is :Will it make any difference in the long run, pills or infusion?

Mozart
How did you get the pump disconnected? Were you able to do at home or did you have to go back to the clinic? If I have infusion, pump put in on Thursday, I can take every other Friday off. I hope to be feeling well enough to return to work on Mondays.

What do you think?

Susan
55 y.o. Female
Dx 9/26/17 RC Stage 3
Completed 33 rad. tx, xeolda 12/8/17
MRI and PET 1/18 sign. regression
Surgery 1/31/18 Ileostomy, clean margins, no lymph node involved
Port 3/1/2018
Oxaliplatin and Xeloda start 3/22/18
Last Oxaliplatin 7/5/18, 5 rounds
CT NED 9/2018

Caat55
Posts: 545
Joined: Sat Dec 23, 2017 6:01 pm

Re: Xeloda vs. 5FU

Postby Caat55 » Wed Feb 21, 2018 8:19 pm

NHMike wrote:I try to stay away from kids when I'm on chemo. I don't think that they're allowed in the cancer center at the local hospital (it's a separate area from the general hospital) unless they have a reason to be there (treatment).



Kids in general just are germ factories. I am a fanatic about hand washing and try to keep a table between me and them. I was super nervous about getting something from one of them and having to postpone surgery.

Susan
55 y.o. Female
Dx 9/26/17 RC Stage 3
Completed 33 rad. tx, xeolda 12/8/17
MRI and PET 1/18 sign. regression
Surgery 1/31/18 Ileostomy, clean margins, no lymph node involved
Port 3/1/2018
Oxaliplatin and Xeloda start 3/22/18
Last Oxaliplatin 7/5/18, 5 rounds
CT NED 9/2018

Caat55
Posts: 545
Joined: Sat Dec 23, 2017 6:01 pm

Re: Xeloda vs. 5FU

Postby Caat55 » Wed Feb 21, 2018 8:21 pm

So the oxi is the big culprit for neuropathy. It am so back and forth with option 1 and 2.

Susan

So my advice is
Option 1: Try Xeloda for one or two cycles and see if you start getting HFS. If so, discontinue and switch to 5FU pump.
Option 2: Start with 5FU pump so there's no risk of HFS, but there will be some inconvenience and different side-effects.
In either case, talk to your onc about your profession and ask them to monitor any neuropathy from the oxaliplatin.

Hope this helps!
Juliej[/quote]
55 y.o. Female
Dx 9/26/17 RC Stage 3
Completed 33 rad. tx, xeolda 12/8/17
MRI and PET 1/18 sign. regression
Surgery 1/31/18 Ileostomy, clean margins, no lymph node involved
Port 3/1/2018
Oxaliplatin and Xeloda start 3/22/18
Last Oxaliplatin 7/5/18, 5 rounds
CT NED 9/2018

Caat55
Posts: 545
Joined: Sat Dec 23, 2017 6:01 pm

Re: Xeloda vs. 5FU

Postby Caat55 » Wed Feb 21, 2018 8:22 pm

mhf1986 wrote:DH did 5FU for 12 months and switched to Xeloda. He was on 3000mg a day. Diarrhea for most of the time, peeling hands and feet. Bilirubin went up so the onc delayed treatment for 7 weeks. He has now switched back. Yes, it was nice not carrying around the pump and it was nice going every 3 weeks (for the 3 treatments it lasted) but the side effects were too much.

Each person will react differently!

M


How did the pump get disconnected?

Susan
55 y.o. Female
Dx 9/26/17 RC Stage 3
Completed 33 rad. tx, xeolda 12/8/17
MRI and PET 1/18 sign. regression
Surgery 1/31/18 Ileostomy, clean margins, no lymph node involved
Port 3/1/2018
Oxaliplatin and Xeloda start 3/22/18
Last Oxaliplatin 7/5/18, 5 rounds
CT NED 9/2018


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