Xeloda or 5FU

[butrflies]

Hi all,

Have made a decision to get chemo treatment at a cancer center close to home and just visited with my oncologist today. Will be going on Folfox6 after I get my pet scan and port inserted. I see him in two weeks to let him know if I wanted to go on 5FU or Xeloda, he also is suggesting that i add Avastin to it. He thinks that my insurance will cover the Avastin but not 100% sure, the clinical trial they were running with it just closed.

I'm having a hard time deciding between the 5FU and Xeloda, would love to hear from anyones experience on how they came to a decision.

Overall I'm doing really good from the support of family and friends and all your posts on this site. I find that some days I'm depressed or maybe just the shock of having colon caner is over and it is becoming real. Had surgery on the 25th of September and my last bandage fell off today. Seeing the scar has definitely made this experience very real. I'm figuring this is all normal and look forward to going back to work.


Thanks
Amy
stage 3c

[ASTEPHENS33]

I took Xeloda. It was shown to be as effective as 5FU, but to my knowledge all the trials with FOLFOX (oxilplatin added) were with 5FU and there have been none with Xeloda and oxilplatin, although my oncologist said either Xeloda or 5FU would be o.k.

5FU is a standard use drug in the fight against cancer. It has been used since the 1950s. A second drug is administered with 5FU called leovorcin, which helps the assimilation of the 5FU. An oral form of the 5FU, which interacts with cancer cells enzymes began testing in 1998. Its been approved for breast cancer for some time. One of the latest studies on this is a New England Journal Medical from June 30, 2005, discussing a study done with about 2000 patients taking either 5FU or Xeloda. The study basically indicated that Xeloda was as effective as the IV form. The toxic effects were also shown to be less and delayed with Xeloda, except in the instance of getting what is called hand-foot syndrome where you get redness or possibly blisters. 5FU would be administered by going in and getting some as of the medication as an IV at the facility and then being given a pump that would go through the IV for 46 hours. You'd return to the facility to have it removed. (I connected with some people on the web, who had a home nurse come by and do the removal.) You do this every two weeks for 12 weeks. Xeloda is taken twice every day for two weeks and then you're off a week and start again for a total of eight 3 week cycles. I decided to go with the Xeloda, due to the less toxicity and less dependence on an IV and logistics.

[ASTEPHENS33]

I took Xeloda. It was shown to be as effective as 5FU, but to my knowledge all the trials with FOLFOX (oxilplatin added) were with 5FU and there have been none with Xeloda and oxilplatin, although my oncologist said either Xeloda or 5FU would be o.k.

5FU is a standard use drug in the fight against cancer. It has been used since the 1950s. A second drug is administered with 5FU called leovorcin, which helps the assimilation of the 5FU. An oral form of the 5FU, which interacts with cancer cells enzymes began testing in 1998. Its been approved for breast cancer for some time. One of the latest studies on this is a New England Journal Medical from June 30, 2005, discussing a study done with about 2000 patients taking either 5FU or Xeloda. The study basically indicated that Xeloda was as effective as the IV form. The toxic effects were also shown to be less and delayed with Xeloda, except in the instance of getting what is called hand-foot syndrome where you get redness or possibly blisters. 5FU would be administered by going in and getting some as of the medication as an IV at the facility and then being given a pump that would go through the IV for 46 hours. You'd return to the facility to have it removed. (I connected with some people on the web, who had a home nurse come by and do the removal.) You do this every two weeks for 12 weeks. Xeloda is taken twice every day for two weeks and then you're off a week and start again for a total of eight 3 week cycles. I decided to go with the Xeloda, due to the less toxicity and less dependence on an IV and logistics.

[butrflies]

Thanks for responding ASTEPHENS33!! Did you take Xeloda with Oxilplatin? or can you not take these two together? Did you find it hard keeping track of when to take your pills or did you miss any doses?

Is Xeloda better than 5FU or do they do the same for the exception of the side effects? I heard that Xeloda attacks only the cancer cells where 5FU attacks all cells, has anyone else heard this?

Thanks again!
amy

[Christine]

Amy,

I have experience taking 5FU (with Leucovorin and Oxaliplatin) and Avastin and I am currently taking Xeloda and Avastin. Studies have shown that they both (5FU vs Xeloda) have the same effect on the cancer cells.

Regarding the side effects, 5FU was more concentrated for me. I felt like crap the whole time I had the pump, but once it was removed, I would start to feel better. I would basically sleep for the two days I was getting it. Xeloda is sneakier. I get waves of nausea, but they pass pretty quickly. My hair is thinning pretty dramatically. The soles of my feet are sore. They're mostly annoyances. It doesn't seem to affect my schedule the way 5FU did.

I am no longer on Oxaliplatin because I developed a toxicity (allergy) to it after almost 5 months of treatments (this is very common), so I don't have any experience with it and Xeloda. From what I've read, they have not studied Xeloda with other drugs.

[Hannah]

A new study (presented just a few weeks ago at the European Society for Medical Oncology) showed that Xelox (Xeloda plus oxaliplatin) is as safe and as effective as FOLFOX (IV 5FU and leucovorin plus oxaliplatin). It also showed that adding Avastin to either Xelox or FOLFOX significantly improved progression-free survival compared to chemo alone.

Whether you do Xelox or FOLFOX is a personal choice, but patients on studies do prefer Xelox because of the convenience - for instance, patients on the Xelox regimen had 60% fewer hospitals visits than those on FOLFOX. Either way, I would definitely add Avastin if you can possibly figure out a way to do it. More info on this study at these sites:
http://www.esmo.org/news/?news_id=44
http://www.esmo.org/news/?news_id=45

Also just a quick reminder - since you will be taking oxaliplatin either way, be sure that you are being "pre-treated" with IV calcium/magnesium, which has been shown to reduce the neuropathy of oxaliplatin.

Hannah

[ASTEPHENS33]

Hannah, thanks for the references on Xeloda with Oxiplatin. That's good to know.

I only did Xeloda. I did not get nausea or lose my hair, but my feet and hands were a problem. I ended up wearing cotton gloves and lost several toe nails. I ended up getting a stationery bike for exercise. My feet were like having blisters on them - manageable, but not pleasant. I found the logistics of taking the pills quite reasonable. I got more tired towards the end of the 6 months. Also, my weight stayed consistent the first four months and then I gained about 1.5 pounds a week - eating about the same amount.

[NICK THE BRIT]

Hi Amy,

Im currently taking both oxaliplatin and xeloda together. I have the oxy drip infused at hospital, then take two weeks of xeloda tablets home with me then you get a week off. (3 week cycle) I have previously posted that i was tolerating the xeloda well. This is my 5th session with 3 to go. But this last week my feet have got very sore and blistery. Im soaking them in warm salty water and applying loads of cream throughout the day. But am finding it difficult to walk on them. My onco has said that clinical trials have proved there is a greater chance it wont come back with this combined therapy so im trying to grin and bear it. Hope this helps.

Nick xx

[Jeni]

Hey, all, I thought that Avastin was not approved for stage 3 colorectal cancer -- I know someone is using it on this group but as part of a study.

I would be very interested to know if Stage 3 folks can get Avastin added to their treatment regimen.

Thanks -

Jeni

[Hannah]

You are right, Jeni - Avastin is not approved for first-line stage III disease (yet!). The results that were presented in Europe were just trial results, and I don't know how they will affect the approved therapies in the U.S.

Keep in mind that just because it's not approved" doesn't mean that your insurance won't pay for it. It may be difficult, but it may have just gotten easier because of this new data.

There are also several current clinical trials for stage II and III patients - see some listings below. I urge anyone who qualifies to check out these trials - remember, you would be getting at least the standard of care, and have the possibility of being placed on Avastin in addition to your regular chemo.


1) This is a phase III trial adding either Avastin (bevacizumab) or Erbitux (cetuximab) to either FOLFOX or FOLFIRI for initial treatment of either locally advanced (stage III) or metastisized (stage IV) disease:
http://www.emergingmed.com/pub_search_t ... e_sys_id=0

2) This is a phase III trial adding Avastin to FOLFOX for initial treatment of stage II or stage III patients:
http://www.emergingmed.com/pub_search_t ... e_sys_id=0

3) This is a phase III trial for stage II patients that compares no chemo at all (observation only) to two different chemo arms - FOLFOX with Avastin and FOLFOX without Avastin:
http://www.emergingmed.com/pub_search_t ... e_sys_id=0

4) This is a phase III trial for patients who received chemo and radiation prior to surgery for stage II or stage III rectal cancer - it will test FOLFOX with or without Avastin, which will sometimes be given prior to chemo and sometimes after chemo: http://www.emergingmed.com/pub_search_t ... e_sys_id=0


These are just "quick" explanations of the trials - check out the link to read more about the purpose of the trial, patient eligibility, and exactly what regimen patients would get.

Hannah

[Bryan S]

Xeloda is an oral form of 5FU. Capecitabine is relatively noncytotoxic in vitro. This drug is enzymatically converted to 5-fluorouracil in vivo. So it is an easier to take version for most people.

[gocatsgo]

I found the Xeloda much easier to take then the folfox, or even the 5FU without the ox. I actually had to stop the ox, then the 5FU infusions altogether due to side effects (left sided weakness/numbness). The Xeloda did give me sores on my feet, for which I found bag balm to be the best remedy. I often felt nauseas, especially if I did not eat enough when I took the pills, BUT this was nothing compared to how I felt during and after the infusions.

I often worry about recurrence because I could only do the Xeloda alone. Though, I would hope that the 3 sessions of Folfox did something anyway. I am curious about these trials w/the Avastin. I have also read about using the Pentaumunab - or however you say it - being used as well.

I would print out the trials, mention them to your oncologist, then let him/her give you his/her best opinion - then go for it. Good luck to you.

[Guest]

I was never given the option of taking Xeloda? Maybe because I had stage 4 colon cancer liver mets. After my colon surgery I went on 4 months of Avaistan and Folfox to shrink the tumors on my liver. Then after my liver surgery I went on cpt 11 and fulfurry and also chemo to my hepatic artery pump for 6 months - clean up chemo. Happy to say I have been NED since my liver surgery July 2005 off Chemo now going on 8 months.... I researched everything about the chemo drugs for different stages of colon cancer I bought it all to my oncologists attention and we together came up with a game plan. I opted for the most aggressive chemo I could get. I was not concerned about how sick I would get I just wanted the beast dead! I had some tough times and had to give myself injections of nupregion (like neulasta) to keep my counts up to stay on schedule that was tough and they hurt and caused a lot of bone pain- but I was determined to stay on course -So far it has worked. Good Luck.