Xeloda question

[junel1025]

I was unable to tolerate 5 FU and just started on Zeloda. I was prescribed 6 tabs a day @ 500mg ea. durations of 14 days, then 7 off. After the first two days, I had a bad reaction similiar to the 5 FU. I stopped taking it and now wonder where do I go from here?

[weisssoccermom]

What type of reaction did you have? Have you talked to your doctor about it? What does he/she say.

[Patience]

I'll direct you to this earlier thread, which has commentary that might be of interest to you.
viewtopic.php?f=1&t=42939

Included is info an testing prior to using Xeloda or 5FU, and that 30% of the people who get those drugs have a serious or fatal reaction, and that it could be expected if you have a bad reaction to one of them that you might have a bad reaction to the other.

My husband had problems with Xeloda, so 5FU was ruled out. He's move on to other chemos/drugs, working his way down the list.

[elise]

My dose had to be reduced twice. Perhaps this is an option your onc can look at?

[junel1025]

Thank you so much for your responses. I have not yet discussed with my doctor. the reactions were very similar to 5fu only this time I didn't end up in the hospital. interesting that with the extremely severe reaction to 5fu that she would recommend zeloda. I will check out the test you suggest

[horizon]

I remember reading about people that had problems when switching from 5FU to Xeloda immediately. I don't know how much truth their is to it but maybe ask you doctor to research it?

http://fightcolorectalcancer.org/resear ... de_effects

[Patience]

Thank you so much for your responses. I have not yet discussed with my doctor. the reactions were very similar to 5fu only this time I didn't end up in the hospital. interesting that with the extremely severe reaction to 5fu that she would recommend zeloda. I will check out the test you suggest

I was told that the test could be useful in showing certain people who might be sensitive to Xeloda/5FU. But, the test does not show everyone who might be sensitive, just those that the test can detect. In other words, you could still be sensitive to the drugs, yet the test not show that particular sensitivity.

I wonder, now that you've already had a personal experience of sensitivity, is the test now even useful? Because you already KNOW you are sensitive. If it was me, I'd worry about having a false sense of security if the test should come back OK.

My husband just moved on to other chemos/drugs since Xeloda was not a good match for him.

[Patience]

I remember reading about people that had problems when switching from 5FU to Xeloda immediately. I don't know how much truth their is to it but maybe ask you doctor to research it?

http://fightcolorectalcancer.org/resear ... de_effects

How interesting. The trial was from 2008, and states:
Conclusion

In chemotherapy-naı¨ve patients, capecitabine produced more toxicity than FU/LV, but at levels in line with previously reported data. However, treatment with capecitabine after FU/LV caused markedly increased toxicity, indicating a sequence-specific interaction. The mechanism has not been determined, but interaction with intracellularly retained folate after FU/LV therapy is a possibility. Oncologists need to be aware of this risk if considering crossing patients over from FU/LV to capecitabine-based regimens.

http://jco.ascopubs.org/content/26/20/3411.full.pdf+html
The conclusion in the Journal of Oncology full article states:

In conclusion, from a clinical viewpoint, we have identified a significant and potentially life-threatening, sequence-specific toxicity
when switching patientsfrom FU/LV to capecitabine. Themechanism is currently undetermined, but one possible reason is persisting intracellular folate repletion following LV dosing. Our experience and current knowledge preclude us from recommending a specific safe
washout period or dose reduction for patients switching from FU/LV to capecitabine. However, oncologistswanting to switch patientsfrom
FU/LV to capecitabine need to be aware of this risk and should exercise due caution. This caution should also be extended to switching
patients from combination regimens containing FU/LV to capecitabine-containing equivalents (eg, from infusional FU/LV with oxaliplatin to capecitabine with oxaliplatin).

http://theoncologist.alphamedpress.org/content/7/4/288.long
Meanwhile, while trying to find a follow up (something more current that 2005, which by the way I could not find online), I saw this statement in the Oncologist, 2o002:

Although 5-FU is still the most widely prescribed agent for the treatment of colorectal cancer, less than one-third of patients achieve objective responses.

IS THIS STILL ACCURATE?? Only 1/3 have the hoped for (objective) response from having 5-FU?

[pukalania]

Not sure if this would help but we add 200mg Celebrex twice a day with each does of xeloda good luck

[Patience]

Not sure if this would help but we add 200mg Celebrex twice a day with each does of xeloda good luck

Pukalania, is that part of a study, or standard protocol by your doctor? Just wondering how/why the Celebrex is being added.

[DLA]

I didn't see a response to the question of what kind of reaction you had to both 5FU and Xeloda. I took Xeloda for 6 months and if you would be kind enough to share what issues you had, I and others could possibly provide some suggestions for dealing with the side-effects. I wish you the best and hope that a chemo treatment plan can be found that you will be able to tolerate. Taking chemo isn't fun and there is a certain amount of 'hang with it' that needs to be employed.

Al the best,
Donn

[Patience]

I didn't see a response to the question of what kind of reaction you had to both 5FU and Xeloda. I took Xeloda for 6 months and if you would be kind enough to share what issues you had, I and others could possibly provide some suggestions for dealing with the side-effects. I wish you the best and hope that a chemo treatment plan can be found that you will be able to tolerate. Taking chemo isn't fun and there is a certain amount of 'hang with it' that needs to be employed.

Al the best,
Donn

Donn, junel1025 reactions might have been way beyond what could be dealt with by suggestions for handling side-effects. For example, my husband ended up in the hospital. It was much worse than solve-it-at-home-side-effects, and no amount of "hang with it" could have overcome the problem.

But you are right in holding hope that a treatment plan can be found that is tolerable.

[bellavida]

I did all six months of my post resection therapy on xeloda. 14 on and 7 off. I started with 4am and 4pm pills. Heavy dose for a 140lb woman. I did have severe hand and foot and my dose was reduced throughout the duration. I still had the same results but they were just more bearable. By the last round I was on 3am and 2pm pills. Good luck

[Patience]

My guess is that most likely the reactions that caused the hospitalization for junel1025 from 5FU were much worse than a rash, etc. (Remember the earlier info that 30% of the people who get those drugs have a serious or fatal reaction.)

I hope she checks back in with an update.

[bellavida]

Hand and foot is not always "just a rash". One round my feet were burning and stinging so bad I couldn't walk. I couldn't even wear socks with loops. I had to wear only the smooth type with crocs because my feet were also swollen. Same for my hands, no matter how much cream or lotion or bag balm I used my cuticles were cracked and bleeding and I couldn't stand the temperature of the water I showered with. That was my first reduction and delay of treatment. A week into the next round, the whole pad (thickness) of both of my feet peeled off. Not just dry skin peeling, the WHOLE bottom of my foot. Oh and my thumbs too. This happened twice during the duration of my chemo. FYI when your feet are already raw, it kind of hurts when they peel again.