Xeloda dosage

[msbfava]

Hi Everyone

I am interested in hearing the doses of xeloda others are taking. I just started it as I was suppose to start taking Folfox but I have a surgical wound that is not healing on my butt and the oncologist is concerned about infection, so we opted for the Xeloda, which she said was five percent less effective but fifty percent less toxic.

However, I was on low dose 5FU during radiation of 500 mg a day, now the xeloda is almost 4000 mg a day, seems a bit excessive to me. Would love to hear feedback

Brenda

[betsydoglover]

The radiation dosage of Xeloda is much lower than the one you use for full blown chemo.

Don't know your height/weight, but what you are taking now sounds reasonable. I was taking 4500mg per day (divided into two doses of course).
Take care,

[nkoske]

Hi Everyone

I am interested in hearing the doses of xeloda others are taking. I just started it as I was suppose to start taking Folfox but I have a surgical wound that is not healing on my butt and the oncologist is concerned about infection, so we opted for the Xeloda, which she said was five percent less effective but fifty percent less toxic.

However, I was on low dose 5FU during radiation of 500 mg a day, now the xeloda is almost 4000 mg a day, seems a bit excessive to me. Would love to hear feedback

Brenda

I haven't heard the 5% less effective but 50% less toxic thing. Pretty sure Xeloda showed equivalence in most studies and potential superiority in a couple. As for issues I think they trade off. Keep in mind that Oncs often participate in the profits of infusion centers. An Onc makes no money by prescribing a Xeloda, that money goes to Roche (or generic mfg). I will tell you the economics do shade treatments.

RESULTS
Disease-free survival in the capecitabine group was at least equivalent to that in the fluorouracil-plus-leucovorin group (in the intention-to-treat analysis, P<0.001 for the comparison of the upper limit of the hazard ratio with the noninferiority margin of 1.20). Capecitabine improved relapse-free survival (hazard ratio, 0.86; 95 percent confidence interval, 0.74 to 0.99; P=0.04) and was associated with significantly fewer adverse events than fluorouracil plus leucovorin (P<0.001).
Conclusions
Oral capecitabine is an effective alternative to intravenous fluorouracil plus leucovorin in the adjuvant treatment of colon cancer.

RESULTS
The safety population comprised 1,864 patients, of whom 938 received XELOX and 926 received FU/LV. Most treatment-related adverse events (AEs) occurred at similar rates in both treatment arms. However, patients receiving XELOX experienced less all-grade diarrhea, alopecia, and more neurosensory toxicity, vomiting, and hand-foot syndrome than those patients receiving FU/LV. Compared with Mayo, XELOX showed fewer grade 3/4 hematologic AE and more grade 3/4 gastrointestinal AE. Compared with RP, XELOX showed less grade 3/4 gastrointestinal AE and more grade 3/4 hematologic AE. As expected grade 3/4 neurosensory toxicity and grade 3 hand-foot syndrome were higher with XELOX. Treatment-related mortality within 28 days from the last study dose was 0.6% in the XELOX group and 0.6% in the FU/LV group.
Conclusion
XELOX has a manageable tolerability profile in the adjuvant setting. Efficacy data will be available within the next 24 months.

Results
The intent-to-treat population comprised 634 patients from the original two-arm portion of the study, plus an additional 1,400 patients after the start of the amended 2
2 design, for a total of 2,034 patients. The median PFS was 8.0 months in the pooled XELOX-containing arms versus 8.5 months in the FOLFOX-4–containing arms (hazard ratio [HR], 1.04; 97.5% CI, 0.93 to 1.16). The median overall survival was 19.8 months with XELOX versus 19.6 months with FOLFOX-4 (HR, 0.99; 97.5% CI, 0.88 to 1.12). FOLFOX-4 was associated with more grade 3/4 neutropenia/ granulocytopenia and febrile neutropenia than XELOX, and XELOX with more grade 3 diarrhea and grade 3 hand-foot syndrome than FOLFOX-4.
Conclusion
XELOX is noninferior to FOLFOX-4 as a first-line treatment for MCRC, and may be considered as a routine treatment option for appropriate patients.

Xeloda by itself alone is given at a rate of 1250 mg/m^2 twice daily according to the NCCN. You can find you body surface area here: http://halls.md/body-surface-area/bsa.htm

My body surface area is about 2 so that would put me at 2500mg (5 x 500mg pills) twice daily or 5000mg per day.

[O Stoma Mia]

Hi Everyone

I am interested in hearing the doses of xeloda others are taking. I just started it as I was suppose to start taking Folfox but I have a surgical wound that is not healing on my butt and the oncologist is concerned about infection, so we opted for the Xeloda, which she said was five percent less effective but fifty percent less toxic.

However, I was on low dose 5FU during radiation of 500 mg a day, now the xeloda is almost 4000 mg a day, seems a bit excessive to me. Would love to hear feedback

Brenda

Brenda - As other have already said, whether 4,000 mg/day is excessive or not depends on your weight and height. Xeloda dose is determined by Body Surface Area. If my calculations are correct, then I think a dose of 2,000mg per administration (i.e., 4,000mg per day) is appropriate for someone with a BSA of around 1.53 to 1.66 m2.

To determine your Body Surface Area, you can use the online calculator:

BSA Calculator
http://www.medcalc.com/body.html

If you put your data in and find that the result for you is between 1.53 and 1.66, then, in my opinion, this would be an appropriate dose for adjuvant Xeloda chemotherapy for you according to current dosing standards outlined in the NCCN Guidelines.

Note: When readers reply to your post and give their dosage in absolute terms mg/day, this is useful only if you also know their Body Surface Area. For a large frame, stocky person, 4,000 mg/day might be just right or even a little low, but it might be a bit excessive for a very- short, thin person. It all depends on Body Surface Area and whether they put your correct weight and height into the calculations.

Capecitabine have we got the dose right
http://www.nature.com/nrclinonc/journal/v6/n1/pdf/ncponc1240.pdf

[weisssoccermom]

Also not sure where you onc came up with the 5% less effective. Every study has shown equal efficacy between 5FU/leucovorin and Xeloda....and many studies have actually shown a slight advantage in DFS. As for the side effects, yes, overall Xeloda is less toxic than 5FU but, keep in mind that the hand/foot syndrome IS more likely to occur with Xeloda than with 5FU.

[msbfava]

The 5fu is less toxic than the Oxaliplatin in the Folfox chemo therapy. That is what I meant to refer to sorry.

Brenda

[CRguy]

Notwithstanding what others have posted here concerning BSA dosing,
there are also considerations for patients whose BMI (body mass index) is above 25.

A general reference from ASCO is here and addresses the issue of overweight patients being underdosed with chemo, based solely on BSA dosing as extrapolated from "ideal body weight" estimations.

A specific clinical trial ( currently recruiting ) which could clarify the issue, titled Pilot Study Evaluating Pharmacokinetic Parameters of Capecitabine Dosing in Patients With Advanced Cancer and Elevated Body Mass Index can be accessed here.

Also of note would be consideration of the various regimens utilizing capecitabine in the neoadjuvant, adjuvant and pseudoadjuvant setting either as monotherapy or combination chemotherapy.

Safe to say it is an evolving field of experience and research !

Best wishes
CRguy

[O Stoma Mia]

Notwithstanding what others have posted here concerning BSA dosing,
there are also considerations for patients whose BMI (body mass index) is above 25...

CRguy - Thanks very much for the link. Your point is well taken, and it might be worthwhile starting up a separate thread sometime for discussion of "BMI-high" issues. You can see the reality of the problem by viewing the standard dosing chart displayed in the manufacturer's guideline for the dosing of Xeloda. It is here that they show explicitly (in Table 1 and Table 2) that the recommended dosing for Xeloda is capped at a BSA (body surface area) of 2.19. If the patient is 'larger' than this, the patient only gets the dose for a patient with a BSA of 2.19.

[betsydoglover]

The patient only gets that dose IF the oncologist works by the book, so to speak. Many would dose otherwise, I think, even before this study.

Take care,

[CRguy]

I have also even seen BSA = 2.0 as a maximum referred to in some places.
While the BMI > 25 is the ACSO start of "overweight", it is actually BMI > 30 (obese) where the most significant issues seem to be, and that is what the Clinical Trial specifies as a point of inclusion in the study.

Talk to your doctors folks if you may fall into this category !!!

Cheers
CR

[O Stoma Mia]

...Safe to say it is an evolving field of experience and research !
CRguy

I'm going to bookmark this topic and return to it later after I have had some time to do some further research.

The issue seems to be wider than I had originally thought, and I need to do some research to try to understand the real underlying issue and the kinds of things that are being done about it.

[CrystalSue]

DH takes 2500 mg twice a day. He just started his third cycle. So far, the only side effect he is having is a little bit of dermatitis on his nose. Hydrocortisone cream keeps it from getting too itchy.