WBCs and Xeloda versus 5FU?

Please feel free to read, share your thoughts, your stories and connect with others!
Surroundedbylove
Posts: 3126
Joined: Tue Dec 16, 2008 6:43 am
Location: Seattle

WBCs and Xeloda versus 5FU?

Postby Surroundedbylove » Mon May 18, 2009 8:23 pm

Hi all,

I have rectal cancer but I think both colon and rectal cancer patients/survivors may have insight.

I had Xeloda and oxaliplatin for 6 cycles neoadjuvant chemo along with radiation. The entire time my WBCs were within acceptable range. I then waited 10 weeks before surgery, had the surgery, then waited 5 weeks before FOLFOX started. I've only had one cycle of FOLFOX. On day 14 WBCs were within normal range. On day 15 (today) they had dropped dramatically and chemo is now delayed. My onc will test daily to see if I'm a "late" dropper on 5FU but he is considering suggesting I go back to the Xeloda instead of 5FU. Anyone else out there experience something similar with their WBCs and Xeloda and 5FU? Also, anyone have thoughts on Xeloda adjuvantly versus 5FU (I know 5FU is the standard protocol so am "worried" about doing Xeloda instead but admit I'd love to have the pills instead of the pump from a convenience standpoint.) I responded well to Xeloda and radiation - tumor mass shrunk from approxiately 9 cm to 1.3 cm and the only cancer left were a "few minute foci of cells floating" in the mass and none in the nodes although 4 had been suspicious on PET/CT scan.

Thanks all - I'd love thoughts and input.
Surroundedbylove

Rectal Cancer @ 43, '08
Clinical: T3,N2a,MX (IIIB)
6 wks XELOX & radiation
LAR, colonic j-pouch, & temp ileo '09
Surgical: ypT3,ypN0,ypMX (0 of 20 nodes)
FOLFOX; XELOX
Ileo Takedown ‘09
LARS for 10 years before learning it is finally being studied
InterStim Sacral Nerve Neuromodulator 2019

weisssoccermom
Posts: 5988
Joined: Thu May 10, 2007 2:32 pm
Location: Pacific NW

Re: WBCs and Xeloda versus 5FU?

Postby weisssoccermom » Mon May 18, 2009 8:45 pm

I was on Xeloda both during my radiation and afterwards and never had a problem with my WBC. I never missed a cycle due to any of my blood results. That being said, either protocol is acceptable (ie XELOX or FOLFOX). FOLFOX is only 'standard' with some oncs. Many routinely prescribe the Xeloda instead of the 5FU specifically because it is easier to handle than the infused 5FU. You will, unfortunately, always find oncs who refuse to allow their patients to have the choice and this is done for a few reasons. One would be patient compliance. If an onc feels that a patient would not take the pills, then that onc is not going to prescribe them. Another reason is that the Xeloda is quite expensive and may not be covered under a patient's insurance. Finally, there is a financial reason for the onc clinic. They can control the amount billed for the 5FU/leucovorin but not for the Xeloda pills. I personally find the latter reason deplorable, but there are others on this board who have heard the same story from their oncs.

Although most people tolerate the Xeloda better than the 5FU/leucovorin, there will be some that don't. In addition, although the studies generally show that most side effects are diminished on the Xeloda, one, hand/foot syndrome is quite a bit more prevalent on the Xeloda. You also have to understand that when you do the XELOX protocol, generally, the timing is stretched out. You would start the pills on day one and have the oxi infusion that same day. Then you would keep taking the pills through day 14, rest for 7 days and start the whole process over. Generally though, patients on Xeloda tend to not have to postpone a cycle for blood count issues.

Either way you will be fine. If your onc is giving you the option and you would rather have the pills, by all means take him up on the offer!

Jaynee
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
10+ blood clots, 1 DVT 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
Perform random acts of kindness

Surroundedbylove
Posts: 3126
Joined: Tue Dec 16, 2008 6:43 am
Location: Seattle

Re: WBCs and Xeloda versus 5FU?

Postby Surroundedbylove » Tue May 19, 2009 10:28 am

Thanks Jaynee. Do you (or anyone else out there) know if 5FU is better at getting the microscopic cells because of its delivery method?
Surroundedbylove

Rectal Cancer @ 43, '08
Clinical: T3,N2a,MX (IIIB)
6 wks XELOX & radiation
LAR, colonic j-pouch, & temp ileo '09
Surgical: ypT3,ypN0,ypMX (0 of 20 nodes)
FOLFOX; XELOX
Ileo Takedown ‘09
LARS for 10 years before learning it is finally being studied
InterStim Sacral Nerve Neuromodulator 2019

weisssoccermom
Posts: 5988
Joined: Thu May 10, 2007 2:32 pm
Location: Pacific NW

Re: WBCs and Xeloda versus 5FU?

Postby weisssoccermom » Tue May 19, 2009 11:22 am

Actually if you read the literature on Xeloda, it is better. 5FU is systemically delivered whereas Xeloda is considered more of a 'targeted therapy'. Many people think that you just take the Xeloda and it is converted simply into 5FU and goes systemically throughout your body. That is not the case. Via a complex process, Xeloda is first converted into two different products within the liver (first 5'-DFCR then 5'-DFUR) and is then sent out in the latter form, via the bloodstream throughout the body. This last product (5'-DFUR) must come in contact with the thymidine phosphorylase (TP) enzyme which will then allow it to be converted into 5FU. TP is an enzyme found throughout your body in small amounts and is an ezyme which is required to help cells mutliply. Studies and research have shown that tumor cells have much higher concentrations of the TP enzyme in them than all of our other cells. Prior to being converted into 5FU, the 5'-DFUR enters the blood supply of the tumor and is converted into 5FU within the tumor. Studies have shown in patients taking Xeloda that there is about a 30% higher concentration of 5FU in the tumor tissue itself as opposed to nearby tissue. In addition, studies have also shown that in patients taking Xeloda there is a higher concentration of 5FU within tumor tissues compared with patients taking 5FU/leucovorin. Finally, studies have repeatedly proved that in the metastatic setting, Xeloda offers a significant increase in tumor regression and has a longer disease free period than with the 5FU/leucovorin. Remember, however, that everyone reacts differently so even though the studies may show one thing, an individual's experience may be another.

Jaynee
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
10+ blood clots, 1 DVT 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
Perform random acts of kindness

steve_p77
Posts: 47
Joined: Fri Sep 19, 2008 3:45 pm

Re: WBCs and Xeloda versus 5FU?

Postby steve_p77 » Tue May 19, 2009 3:28 pm

Some oncologists are not comfortable with Xeloda in combination with Oxaliplatin because it hasn't been fully studied, or because they can't collect the clinic fees, or both. Jaynee said that all the studies she saw comparing Xeloda/Oxaliplatin and FOLFOX showed that the Xeloda/Oxaliplatin was as good as FOLFOX or even slightly better, except for one.

Despite the fact that my mother had Xeloda/Oxaliplatin during chemoradiation, which still counts as treatment, we weren't entire sure on the subject so she ended up going with the 5FU which required a mediport surgery, and another in the future to remove it.
mother, age 61
dx July '08 stage II/III rectal cancer
six weeks chemoradiation (Xeloda & Oxaliplatin) Aug - Sept '08
surgery: LAR with temp loop ileostomy January 7th, '09 - 0/8 nodes
Mar '09 FOLFOX for eight cycles
Aug '09 ileostomy takedown

weisssoccermom
Posts: 5988
Joined: Thu May 10, 2007 2:32 pm
Location: Pacific NW

Re: WBCs and Xeloda versus 5FU?

Postby weisssoccermom » Tue May 19, 2009 3:59 pm

It is becoming increasingly more 'popular' to have the Xeloda during radiation simply because of the convenience of it. Having a pump for 48 hours during a FOLFOX treatment may be one thing, but having the port in 24/7 (or in some cases 24/5) for 6 weeks is an entirely different story. I think most patients would GLADLY have the Xeloda for 5-6 weeks instead of the continuous port and that pressure has been successful in changing oncs minds - at least in this scenario.

No one can predict how an individual is going to respond to one drug over another - either in side effects or in efficacy. We all base our treatment decisions on advice and possibly study results, etc. For me, when all are pretty much equal, I take the option that allows me some emotional and psychological control over my treatment. Personally, I would rather take the Xeloda anyday over the 5FU again. My side effects were significantly less on the Xeloda and my emotional well being was rewarded with a huge boost. Everyone has to do what he/she is comfortable with at the time. As I said, my onc was honest about it. As long as I didn't suffer from any side effects (particularly the hand/foot syndrome), he felt quite confident based on the studies and his own experiences with the drug that Xeloda was just as good if not slightly better than the 5FU/leucovorin and he allowed me the choice in the matter.

Jaynee
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
10+ blood clots, 1 DVT 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
Perform random acts of kindness

User avatar
Terry
Posts: 5536
Joined: Wed Oct 03, 2007 10:36 pm
Facebook Username: Terry Minor
Location: Silver Cliff, Wisconsin

Re: WBCs and Xeloda versus 5FU?

Postby Terry » Tue May 19, 2009 4:23 pm

I was on 5FU when I was diagnosed with stage II and I my counts only fell to right below normal. I'm on Xeloda now and I don't have any problems with it really. Actually, I did at first but they dropped my dose from 1800mg twice a day to 1500 twice a day and now it's better. Xeloda from what I read (Xeloda is the pill form of 5FU) targets the cancer cells and less of the good cells. I believe it's a better drug in my opinion. Why did your doctor put you on the 5FU? Perhaps because it's about $29.00 a bag instead of $2400.00 for two weeks. I would ask him what he thinks but I wouldn't be worried that your not getting a good drug by taking the Xeloda, I really think your getting a better drug with less side effects (for most people anyway).

Hope that helps!
Terry
DX 7/3/07
Chemo, radiation, 20 mo. chemo, IMRT, cyberknife, 6/11 lobectomy.
1/16 resection perm. colostomy intraop. rad.
PET 2/12 nose, thyroid, liver, lngs
Folfox 3/12
Lord I know You'll keep me here until
you know I cannot suffer any longer!

Surroundedbylove
Posts: 3126
Joined: Tue Dec 16, 2008 6:43 am
Location: Seattle

Re: WBCs and Xeloda versus 5FU?

Postby Surroundedbylove » Tue May 19, 2009 6:10 pm

Thank you all - Jaynee - great explanation!

Terry - my doc suggested that I start with 5FU adjuvantly because of the extreme, extreme fatigue I had when on the Xeloda neoadjuvantly. In his experience more patients have extreme fatigue on Xeloda than on 5FU and slightly more mucositis. He has been a great doc though and he has always said everyone can react differently. I really don't think in his case or his group practice case that it is driven by the dollars - thankfully. I also had severe, severe abdominal cramping neoadjuvantly although we attribute most of that to the radiation. But he was concerned with my neoadjuvant side effects enough that adjuvantly he was trying to see if something would be a little "gentler" on my system while still going for a cure to the cancer.

I'm going to try going back to the Xeloda adjuvantly - my WBCs were up a little today and I just may be a person that has better counts on Xeloda than 5FU. I also may have less mucositis on Xeloda than 5FU based on the first week reaction to 5FU. So, next week chemo resumes assuming the counts continue to go up.

Jaynee - interesting cycle difference though - he does Day 1 oxaliplatin and start the Xeloda. Continue the Xeloda for seven days then a seven day break then start again - so overall still a two week cycle.

Thank you all so much - it is great to have people out there with whom you can bounce around thoughts and concerns.
Surroundedbylove

Rectal Cancer @ 43, '08
Clinical: T3,N2a,MX (IIIB)
6 wks XELOX & radiation
LAR, colonic j-pouch, & temp ileo '09
Surgical: ypT3,ypN0,ypMX (0 of 20 nodes)
FOLFOX; XELOX
Ileo Takedown ‘09
LARS for 10 years before learning it is finally being studied
InterStim Sacral Nerve Neuromodulator 2019

weisssoccermom
Posts: 5988
Joined: Thu May 10, 2007 2:32 pm
Location: Pacific NW

Re: WBCs and Xeloda versus 5FU?

Postby weisssoccermom » Tue May 19, 2009 6:36 pm

That must be a newer way to do the XELOX protocol as it is not what has been the 'norm'. One thing to point out is this. While fatigue can be attributed to either Xeloda or 5FU/leucovorin, in all likelihood, the extreme fatigue that you mentioned during chemoradiation is probably due more to the radiation than the chemo. Radiation takes its toll on patients - the most prevalent of which is fatigue. Just out of curiosity - what were your blood counts during chemorad treatments? It's not at all uncommon to become quite anemic (leading to fatigue) during these treatments and that is directly related to the radiation treatments. As for me, I was much much more fatigued on the 5FU than the Xeloda. In looking at the table of side effects, the distribution is about equal between the two for fatigue, however, there is a slightly higher incidence of grade 3/4 fatigue on 5FU/leucovorin than on Xeloda.

It is certainly worth a try, however, to switch and see how you do. Hopefully your counts will stay up and allow you to continue your cycles without much interruption and you won't experience too much fatigue.

Jaynee
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
10+ blood clots, 1 DVT 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
Perform random acts of kindness

Surroundedbylove
Posts: 3126
Joined: Tue Dec 16, 2008 6:43 am
Location: Seattle

Re: WBCs and Xeloda versus 5FU?

Postby Surroundedbylove » Tue May 19, 2009 8:13 pm

Yes, we did attribute the extreme fatigue then predominantly to the combined chemo/radiation. This first 5FU cycle gave me about the same fatigue that I had week six of the chemo/radiation - grade 4. Glad to hear you had less fatigue with the Xeloda - I'm hoping I'll have the same result.

I did get low HCT during the neoadjuvant treatment - two blood transfusions helped immensely. On the WBC side of things the lowest I got was 2.4 - one week after the sixth cycle. During XELOX neoadjuvantly the WBC counts went from 7.1 to 8.1 to 7.8 to 6.6 to 4.0 to 2.6 during treatment and then to 2.4 to 3.3 the first two weeks after treatment. For this one FOLFOX treatment I dropped from 6.8 to 1.7. I'm glad to go back on the XELOX - hoping my WBCs will rebound and do better on XELOX.
Surroundedbylove

Rectal Cancer @ 43, '08
Clinical: T3,N2a,MX (IIIB)
6 wks XELOX & radiation
LAR, colonic j-pouch, & temp ileo '09
Surgical: ypT3,ypN0,ypMX (0 of 20 nodes)
FOLFOX; XELOX
Ileo Takedown ‘09
LARS for 10 years before learning it is finally being studied
InterStim Sacral Nerve Neuromodulator 2019

User avatar
Terry
Posts: 5536
Joined: Wed Oct 03, 2007 10:36 pm
Facebook Username: Terry Minor
Location: Silver Cliff, Wisconsin

Re: WBCs and Xeloda versus 5FU?

Postby Terry » Wed May 20, 2009 5:33 am

I get the oxi and Avastin then start the Xeloda when I get home for a 14 day cycle. I actually get more tired after I stop the Xeloda which is probably when my counts start dropping. They say they drop around days 11 to 14 which can be from any of the chemos. My WBC's were O.K. but my RBC's are slightly before normal and my HBG AND HCT both are at the low ends now. I'm really hoping they don't decrease to the point of transfusions! Yuck, just another procedure.

Good luck with the Xeloda, I hope it was the radiation that made you so tired.
DX 7/3/07
Chemo, radiation, 20 mo. chemo, IMRT, cyberknife, 6/11 lobectomy.
1/16 resection perm. colostomy intraop. rad.
PET 2/12 nose, thyroid, liver, lngs
Folfox 3/12
Lord I know You'll keep me here until
you know I cannot suffer any longer!

Surroundedbylove
Posts: 3126
Joined: Tue Dec 16, 2008 6:43 am
Location: Seattle

Re: WBCs and Xeloda versus 5FU?

Postby Surroundedbylove » Wed May 20, 2009 10:11 am

Thanks Terry. I hope you don't have to have the transfusions either but admittedly I felt MUCH better after having them as my HCT would go up quite dramatically and immediately. As soon as my HCT would drop below 30 my oncologist would authorize the transfusion because of my Grade 4 fatigue.

A friend of mine is going through treatment for ovarian cancer and she also has had to have two transfusions so far. We call them our "vampire cocktail" or "vampire energy drink" as a way to interject some humor into the process.

Jaynee - any literature on the targeted nature of Xeloda when there is no longer a tumor in the body because its been removed and the chemo is just trying to clean-up any lingering cells in the body? My oncologist talked about the targeted therapy aspects of Xeloda neoadjuvantly as one the primary reasons he goes straight to Xeloda for neoadjuvant treatment. In the adjuvant setting he thinks it is equally effective. Just curious if you've seen literature on its use adjuvantly.

Thanks all!
Surroundedbylove

Rectal Cancer @ 43, '08
Clinical: T3,N2a,MX (IIIB)
6 wks XELOX & radiation
LAR, colonic j-pouch, & temp ileo '09
Surgical: ypT3,ypN0,ypMX (0 of 20 nodes)
FOLFOX; XELOX
Ileo Takedown ‘09
LARS for 10 years before learning it is finally being studied
InterStim Sacral Nerve Neuromodulator 2019

User avatar
Ivona
Posts: 2048
Joined: Mon Jan 19, 2009 12:39 pm
Facebook Username: Ivona Bradley
Location: Ottawa, Canada

Re: WBCs and Xeloda versus 5FU?

Postby Ivona » Wed May 20, 2009 4:01 pm

Terry wrote:I was on 5FU when I was diagnosed with stage II and I my counts only fell to right below normal. I'm on Xeloda now and I don't have any problems with it really. Actually, I did at first but they dropped my dose from 1800mg twice a day to 1500 twice a day and now it's better. Xeloda from what I read (Xeloda is the pill form of 5FU) targets the cancer cells and less of the good cells. I believe it's a better drug in my opinion. Why did your doctor put you on the 5FU? Perhaps because it's about $29.00 a bag instead of $2400.00 for two weeks. I would ask him what he thinks but I wouldn't be worried that your not getting a good drug by taking the Xeloda, I really think your getting a better drug with less side effects (for most people anyway).

Hope that helps!
Terry


I was on Folfox and due to nasty side effects am now on my 2nd cycle of Xeloda. For me, Xeloda is a god send because I really did not tolerate Folfox very well...mostly the oxali I think. I pay $780.00CAN per treatment. My group insurance pays 80% and Roche will cover the rest.
dx'd Oct '08 (age 48)
T3bN2Mx
9/23 LN's
resection Nov '08
Folfox Jan '09 - March '09
Xeloda March 24/09 - July 6/09

"Yesterday is history, tomorrow is a mystery, but today is a gift. That is why it's called 'the present'. "

jdegeorge

Re: WBCs and Xeloda versus 5FU?

Postby jdegeorge » Tue Jun 02, 2009 8:16 pm

My mother-in-law is on Oxaliplatin IV with Avastin every 3 weeks and 3 Xeloda 500 MG pills 2x/day for two weeks then one week off. She's been hospitalized twice with dehydration and c-diff collitis, which after the 2nd time discovered it was the Xeloda.

The doctor says she has to stop all treatment, which is a sin because her CEA went from 518 before any treatments to 43 after just 4 treatments. She has mCRC, so we know it can't be cured, but we're hoping he can start another protocol. The 5-FU infusion process is not going to be easy for her to do. Is there something else that can be done?


Return to “Colon Talk - Colon cancer (colorectal cancer) support forum”



Who is online

Users browsing this forum: No registered users and 117 guests