Xeloda (pill form) or 5FU (infusion form)?

[ketel]

Hi gang,

Does anyone have any experience with taking Xeloda via pill form versus taking 5FU by infusion in their FOLFOX protocol? Apparently, they are essentially the same drug.

I have met with two oncologists thus far. One is recommending FOLFOX with the 5FU in infusion form (which would involved wearing the 48 hour pump) while another is partial to Xeloda instead of the 5FU. Obviously, taking the pill would be far more convenient (no pump and no 48 hour return to the hospital to have it unhooked.) Some docs say there is no difference in the efficacy of one over the other; other docs feel better about the 5FU via infusion method?

Any experience here?

Thanks everyone.

ketel

[Hannah]

It has been proven that Xeloda is just as effective as infusional 5FU (the pump). You are right - they are essentially the same drug, but there are differences because of the way the 5FU gets into your system.

Infusional 5FU is pumped directly into your blood and therefore throughout your body, which is how it gets to the tumor. Xeloda is taken orally and metabolized into 5FU inside your body (through your liver and then inside the tumor itself). With infusional 5FU, more 5FU gets into your body, but with Xeloda, more 5FU makes it into the tumor.

Because the 5FU it doesn't get pumped through your blood, Xeloda doesn't affect the rest of your body as much as infusional 5FU. It makes sense because of course the 5FU is poison, so the less you can have throughout your body means less "poisoning" of the rest of your body. That is why the biggest "plus" for Xeloda is that, other than hand & foot syndrome, the side effects are fewer and less severe for most people on Xeloda than for those on infusional 5FU.

The only major problem with Xeloda side effects is that there is greatly increased incidence of hand & foot syndrome (60% of patients on Xeloda had this vs. 9% on 5FU), but almost all other side effects showed a pretty significant improvement on Xeloda. You have less of chance of the following with Xeloda:
- nausea
- diarrhea
- vomiting
- alopecia (hair loss)
- stomatitis (mouth sores)
- neutropenia (low white blood count)

You have about the same chance of having fatigue, lethargy, abdominal pain, astehnia (feeling of weakness), or constipation. Those aren't all of the issues or the differences, but I would say that there is DEFINITELY plenty of evidence that you can pretty much pick which one you want to do. If your doctor is "leaning" towards infusional, I would ask to see the data s/he is relying on in making that decision. Otherwise I would say that probably it is because infusional 5FU has been around a little bit longer, or - and I hate to suggest this - but it is true that some doctors lean towards the infusion because it is more lucrative for their practice than Xeloda, or possibly because they are behind the times and don't know that studies have shown that Xeloda is just as good.

Honestly if I were making the decision, I would probably choose to do the Xeloda regimen. Check with your insurance company to make sure they will cover it (they absolutely should, but double check anyway!). Xeloda is easier (yeah for taking pills at home!) and cheaper and easier to administer. Although the odds are that you will have to deal with hand and foot syndrome, you will also have a much better chance of avoiding some other nasty side effects without giving up anything in terms of how well your treatment works.

Hannah

p.s. Do keep an eye on advances with Xeloda - there have been studies in patients with metastatic disease that show that Xeloda gets a better reponse than infusional 5FU (though not better survival, if that makes sense). Keep in mind that it took four years after Xeloda was indicated for stage IV disease (2001) to get it approved as first-line treatment for stage III (2005). Also, it was only a few years ago that patients got bolus 5FU instead of the pump - so new things are happening all the time.

[NICK THE BRIT]

Hello Ketel,

Like Hannah has stated, my onco in england has advised its better tolerated pill form and not as invasive, im on my 7th course out of 8 of the xeloda along with oxaliplatin (infusion) and to be honest i get on fine with it. Once i get the crappy side effects of the oxy out of the way i feel ok with the tablets. My hands and mouth have been fine. My feet were ok upto about round 5 and then bang!! they went very sore, but at the same time i wasnt putting any cream on them. I now moisturise them morning, noon, then night and am keeping on top of it. So personally i would say go for the tablets. Hope this is of help

Regards

Nick

[cynnycal]

Heya
well, i've done 6 rounds of folfox
and i've also done five weeks of taking xeloda (while i was doing radiation)
that was earlier in the summer, before surgery.

so now i've had surgery, have all new plumbing down there, and they wanted me to do 6 more rounds of folfox (precautionary?)
i asked if i could do xeloda again, b/c it was so much easier than folfox. but my oncologist didn't want me to. i think he thought it wasn't as effective as the infusion, and didn't want to risk anything with me. wanted to be as aggressive as possible so as to stave off a possible reoccurance?
(i think. i've noticed that b/c i'm young, and was in very good shape before this all started, they feel i can really hang with very aggressive courses of treatment)

next time i talk to him i'm going to bring up that xeloda is as effective. i mean, i don't know if since i've already started this next couple rounds if they'd even consider switching you half way though.
BUT the 46 hour pump is much better than being stuck in the hospital for three days each time. so that's an improvement for me.

[rthornton]

When I was diagnosed last May, after I had my colectomy I went through 8 rounds of 5FU (with Oxaliplatin and Avastin) by 48 hour infusions. I suffered quite a bit from side effects, but a PET scan showed I was in complete remission after 6 rounds (there were multiple liver mets and they were considered not resectable, hence the aggressive chemotherapy). So I stopped the 5FU, did one CPT-11 infusion that made me too sick so we tried a "maintenance" regimen of Erbitux and Avastin. Even still, I had a recurrence in July in my liver, had a liver resection, now I'm using Xeloda + Avastin. I find the Xeloda much easier to handle than the 5FU, but I'm also not taking the full dosage of Xeloda (only 2500mg daily, two weeks on and then a week off).

I was told, at some point, that cancer cells can mutate and effectively become immune to therapies. For this reason, oncologists will periodically change treatments. Although 5FU and Xeloda are the same drug, they are metabolized differently and so the cancer cells are less apt to become immune to them, so that it's beneficial to use both of the drugs at different points during treatment. This is the very simplistic way that it was once explained to me. I don't know if this is entirely accurate ...

[ASTEPHENS33]

I finished my chemo about six months ago and did Xeloda. The oncology nurse kidded that one of the biggest side effects of Xeloda is that you get tired of taking pills. The logisitcs of not needing a pump, however, was real freedom for me. I don't know what 5FU would have been like, but my experience with Xeloda was overall positive. The one sympton they say is more common with Xeloda is hand and feet syndrome. It go to the point my dosage needed to b e reduced. Hand and feet syndrome was more like when you have blisters - painful, but not dibilitating. I wore glove and extra thick sox with wider shoes. I did get tired - especially at the end.

My onoclogist had me take Celebrex during treatment to reduce symptons. My understanding is that there is a study underway on this, but no official results have been published. My oncologist had to justify the use to the insurance company, since it was a non-standard use, but they approved it. Since the process took a while, I ended up ordering it through Canada and it turned out to be only slightly more than my co-pay here, but in the end I did get the difference reimbursed.

I did Xeloda only. The studies with oxilplatin have all been done with 5FU. The study comparing the effectiveness of Xeloda and 5FU, was without oxilplatin. I think there are studies underway now using Xeloda with oxilplatin, but don't know. My oncologist said that it would be as effective, but don't know the scientific basis of the combintation.

The only other difference that came up, but wasn't an issue for me, was one of cost. Xeloda - since it is oral medication - is covered under drugs under medical plans, but 5FU is covered under regular medical. Xeloda still has patents on it and it is more expensive.