Chemo/radiation - tablets or iv infusion?

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Jess83
Posts: 37
Joined: Sun Dec 02, 2012 7:06 am

Chemo/radiation - tablets or iv infusion?

Postby Jess83 » Sat Mar 06, 2021 4:46 am

Hi!
I have just started my radiation/chemo for 6 weeks. My oncologist has put me of the 5FU pump through my port. Having the pump on me 24/7 is doing my head in! I was just wondering what others have usually had or if anyone has swapped from the pump to tablets during treatment.
From what I’ve researched, there doesn’t seem to be any difference in the efficiency of the chemo from IV to tablet.
Thanks for any feedback :D
2012 - Stage 1, 29 Australia
18mm Polyp - T1 NX M0
May 13 - TEMS procedure, Clear margins!!!
Dec 20 - 35mm tumor next to original resection
Stage 4 with met to adrenal gland
Jan 21 - Adrenal gland removed
3 rounds of FOLFOX
March 21 - 6 weeks of chemo/radiation
April/May 21 - 3 rounds FOLFOX
June 21 - ULAR, loop ileostomy & removal of ovaries - leak, drained, reoccurred, drained again.
August 21 - 6 rounds FOLFOX
November 21 - Clear PET Scan - NED!
December 21 - Ileostomy reversal

Rock_Robster
Posts: 1027
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Chemo/radiation - tablets or iv infusion?

Postby Rock_Robster » Sat Mar 06, 2021 5:44 am

I did Xeloda (capecitabine) tablets for radiation rather than the 5-FU pump as if was much more convenient given the duration (5 weeks for me). Some people have slightly more side effects from tablets, though it’s a much lower dose with radiation than normal. One concern is sometimes regarding compliance over the six weeks. Definitely ask your oncologist if this is something you’re interested in trying - you can always go back to the pump if it doesn’t work out.

Good luck,
Rob
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

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Green Tea
Posts: 451
Joined: Mon Oct 24, 2016 10:48 am

Re: Chemo/radiation - tablets or iv infusion?

Postby Green Tea » Sat Mar 06, 2021 9:48 am

Yes, I agree with Rock_Robster. You should check to see if you could switch to capecitabine.

I think the main reason you are on the 5FU pump right now is that you already have a port from the prior FOLFOX treatment, so it's not much different to use the same port to infuse a reduced dose of 5FU. But, honestly, the tablet option is much more convenient and should be OK along as you keep in mind a few differences:

In terms of compliance, you will have to have a system for insuring that you take the tablets both in the morning and in the evening. Sometimes people forget; sometimes people just sleep through dinner and miss taking the second dose. You need a good alarm clock, or an AM/PM 7-day pill box for storing your pills to make sure you don't miss a dose.

In terms of side effects, there are several capecitabine side effects that are different or more severe than 5FU side effects.

One of these is Hand Foot Syndrome, which causes the skin to fall off the hands and feet and which can also cause problems with the fingernails and toenails. For this, it would help to have a good pedicure and manicure before starting treatment. This is to remove the callouses from the bottom of the feet and to remove the dirt and bacteria from around the nails in order to minimize infection.

Another of these is Mouth Sores. Mouth sores can quickly degenerate into throat sores, then to larynx sores, and finally to the wind-pipe sores and into the lungs as pneumonia within less than a week. It is very important to observe daily good oral hygiene by keeping the teeth and gums clean with a good, soft toothbrush, and rinsing the mouth with a non-alcohol mouthwash or with a salt-water solution after every meal and after every vomit session. The mouth must remain free of food particles and gastric juices as much as possible. If mouth sores do develop, they must be treated properly as soon as possible, without delay.

How to tackle Xeloda side effects
https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=61932&p=490294#p490294

https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=44619&p=321925#p321925

https://www.clatterbridgecc.nhs.uk/download_file/view/2787/424

https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=59315&p=491191#p491191

https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=56940&p=450621#p450543

https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=56940&p=450621#p450542

https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=65193&p=507245#p507245

https://www.oncologynurseadvisor.com/home/departments/ce-courses/prevention-and-management-of-hand-foot-syndromes/
Last edited by Green Tea on Sun Mar 07, 2021 10:29 am, edited 8 times in total.

Siti
Posts: 269
Joined: Thu Aug 01, 2019 10:58 am

Re: Chemo/radiation - tablets or iv infusion?

Postby Siti » Sat Mar 06, 2021 11:22 am

Hello Jess

My husband was on capecitabine and it has been effective. He downloaded an app to ensure that he doesn’t miss a dose plus we try to ensure he takes it at consistent time of the day. We’ll have dinner every day at the same time and then he takes the pills an hour after.

He did suffer bad HFS and occasional tummy cramps and diarrhoea but on the flip side we could go on holiday (pre-pandemic) and it gave him the freedom to exercise etc

Take care
Siti
DH (54) DX on 5/7/19
Sigmoid|G3|LN:30/31|MSS|WT KRAS, NRAS, BRAF
7/19 PET distant LN para-aorta neck hip (0.5-1.5cm)
7/19 Lap resection
26/8 to 20/12/19 CAPEOX+Bev 7x
6/11/19 CT 3 cycle LN shrunk
1/20 Cap+Bev
4/20 TS-1+Bev due to bad HFS
NED 4 years
8/23 PET recurrence chest LN growing since Feb. CEA May(4.5>5.1>5.9)
9/23 Stopped Bev, CEA Sept(8.7) Radio 17x
11/23 PET 1+ supraclavicular LN, CEA (3.4>2.5)
12/23 Lymphadenectomy
1/24 Narrow margins, 1/5 +LN, 1.4cm +tissue, TMB (19)

roadrunner
Posts: 460
Joined: Sun Jan 12, 2020 8:46 pm

Re: Chemo/radiation - tablets or iv infusion?

Postby roadrunner » Sat Mar 06, 2021 4:44 pm

In my view, this is a very complicated topic and decision. I would certainly ask your oncologists (both medical and radiation) why they are using infusional 5FU instead of Xeloda/Capecitabine. I do not think it’s simply because you have a port—I did 4 rounds of neoadjuvant FOLFOX thru a port, then CRT with Xeloda/Capecitabine, then 4 more rounds of FOLFOX. In any case, this decision should not in my view be made on that basis—it should be a medical decision, not one of convenience. There are potential medical/outcome differences between the approaches. Here’s a useful comparison:

https://journals.lww.com/md-journal/Ful ... nt.23.aspx

I wonder instead if your oncologists are using infusional chemo because you are Stage 4, or because of the nature and/or location of your metastasis. I’d also be interested in why you only did three rounds of neoadjuvant FOLFOX—perhaps that is relevant?

Additionally, I saw at least one study that suggested that *switching* from infusional 5-FU to Xeloda/Capecitabine carries increased risk of significant side effects, so that should also be discussed with your doctors. I’ll link in a separate post.

I will add that for me Capecitabine felt like a vacation in comparison to infusional 5-FU (with or without Oxaliplatin). Super easy to tolerate if taken correctly with basically zero side effects at the CRT dosage (I took extra weeks of it before and after CRT as well). I ended up with a “near complete clinical response.” And I found that cancer focuses the mind pretty well on remembering to take it. But see above re: “switching.”

So my bottom line is: Get informed and ask your team what their rationale is. Once you’ve got that info, you will be in a position to decide what to do.
Last edited by roadrunner on Sat Mar 06, 2021 4:50 pm, edited 1 time in total.
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
6/20/22 TAE rectal polyp benign)
NED from 3/22 - 3/23
4 cycles FOLFIRI
LUL VATS lobectomy for radio resistant met 7/7/23

roadrunner
Posts: 460
Joined: Sun Jan 12, 2020 8:46 pm

Re: Chemo/radiation - tablets or iv infusion?

Postby roadrunner » Sat Mar 06, 2021 4:49 pm

Here’s the study on “switching.” I believe these folks were chemo naive, which you aren’t. Also, I in essence “switched” when I bailed out from FOLFOX into CRT/Capecitabine, and had no ill-effects. I think a took a few weeks to get the CRT together, though, in case that matters.

https://fightcolorectalcancer.org/blog/ ... e_effects/
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
6/20/22 TAE rectal polyp benign)
NED from 3/22 - 3/23
4 cycles FOLFIRI
LUL VATS lobectomy for radio resistant met 7/7/23

User avatar
beach sunrise
Posts: 1034
Joined: Thu Mar 05, 2020 7:14 pm

Re: Chemo/radiation - tablets or iv infusion?

Postby beach sunrise » Sat Mar 06, 2021 4:58 pm

I was not told there was a choice. Never knew about xeloda until I joined this forum. I was so mad a choice was not offered. The oral xeloda is so much easier to tolerate all the way around for me. No dang pump ticking/clicking constantly, no cord getting hung on cabinet hardware, no worries about the animals accidently messing it up, showers are easier (ha), HFS is not an issue as long as you take care of it with good lotion every day and ect... JMO.
8/19 RC CEA 82.6 T3N0M0
5FU/rad 6 wk
IVC 75g 1 1/2 wks before surgery. Continue 2x a week
Surg 1/20 -margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24 post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
CEA
7/20 11.1 8.8
8/20 7.8
9/20 8.8, 9, 8.6
10/20 8.1
11/20 8s
12/20 8s-9s
ADAPT++++ chrono
CEA
10/23/22 26.x
12/23/22 22.x
2023
1/5 17.1
1/20 15.9
3/30 14.9
6/12 13.3
8/1 2.1
Nodule RML SUV 1.3 5mm
Rolles 3 of 4 lung nodules cancer
KRAS
Chem-sens test failed Not enough ca cells to test

Rock_Robster
Posts: 1027
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Chemo/radiation - tablets or iv infusion?

Postby Rock_Robster » Sat Mar 06, 2021 7:13 pm

All very good points above. The only other comment I’d make is that we need to be careful to not conflate information about capecitabine/5FU monotherapy, with the much lower dosages used when capecitabine is a radiosensitiser for chemoradiation. I took a total 2,000 mg/d of Xeloda during radiation which I believe would be a bit less than 2/3rds of my standard monotherapy dose (or as part of CAPOX, for example), and at this level I had essentially zero side effects from the Xeloda (the only noticeable one being some mild nausea if I didn’t have a large enough meal beforehand). Of course there were radiation side effects in there too which can make differentiating a little tricky.

In any case of course everyone is different, but I suspect the rates of things like HFS would be significantly lower at the reduced dose and for the relatively short CRT period.
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

Jess83
Posts: 37
Joined: Sun Dec 02, 2012 7:06 am

Re: Chemo/radiation - tablets or iv infusion?

Postby Jess83 » Sat Mar 06, 2021 11:31 pm

Thank you all so much for your responses!
I’m not really sure why we went with 5-FU, I haven’t really had any break between my FOLFOX and CRT, so maybe that is why? I will definitely chat to my oncologist on Tuesday. I’m happy to do whatever they think is the best for my treatment.
Roadrunner and green tea thank you for the links!
2012 - Stage 1, 29 Australia
18mm Polyp - T1 NX M0
May 13 - TEMS procedure, Clear margins!!!
Dec 20 - 35mm tumor next to original resection
Stage 4 with met to adrenal gland
Jan 21 - Adrenal gland removed
3 rounds of FOLFOX
March 21 - 6 weeks of chemo/radiation
April/May 21 - 3 rounds FOLFOX
June 21 - ULAR, loop ileostomy & removal of ovaries - leak, drained, reoccurred, drained again.
August 21 - 6 rounds FOLFOX
November 21 - Clear PET Scan - NED!
December 21 - Ileostomy reversal


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