Xeloda dosing

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Rock_Robster
Posts: 720
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Location: Brisbane, Australia

Xeloda dosing

Postby Rock_Robster » Sun Nov 20, 2022 1:34 am

Hi all, I’ve seen some recent chat in threads including Xeloda (capecitabine) dosing, but rather than hijack those I thought best to start here and ask my questions.

After 4 years managing stage IV rectal cancer, I’ve recently stated on Xeloda + Avastin (capecitabine + bevacizumab). Plan is to stay on this long-term if I can, interspersing with things like SABR/ablation or trials, as appropriate. Initial dosing in Australia is 1250mg/m2 twice daily, so as a 185cm / 83kg guy that works out to 5,000 mg/day. 2 weeks on and 1 week off. The onc said we would almost certainly need to dose reduce at some stage, likely to maybe around 70-80% of this, based on side effects.

I’ve just finished the first 2 weeks and have had to skip a few doses (as he suggested) due to side effects - mainly early appearance of early stage hand/foot syndrome, and early mouth ulcers. So I expect I’ll get a dose reduction next cycle. Wondering where most people end up with their dosages? (eg on a mg/m2 basis).

I’m avoiding added folate / folic acid and doing the topical treatments for the HFS (urea cream, etc) but wondering what peoples’ views on systemic treatments for side effects are that don’t interfere with efficacy? I’ve seen decent data for celebrex (celecoxib) which seems to be synergistic with Xeloda anyway so will restart that, but also hearing melatonin? I was taking 30-40mg nightly anyway but the onc pharmacist suggested I stop due to antioxidant effects on the Xeloda. Any thoughts welcome!

Cheers,
Rob
Last edited by Rock_Robster on Sun Nov 20, 2022 9:44 am, edited 1 time in total.
40M Australia
2018 RC, 12cm high
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11/22 Liver mets, possible peri nodules. Xeloda+Avastin

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beach sunrise
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Re: Xeloda dosing

Postby beach sunrise » Sun Nov 20, 2022 3:03 am

Definitely find high dose IVC and add celebrex and vitamin E with selenium.
30 min's before breakfast I take my cancer pathway blockers, then eat breakfast and take xeloda, celebrex, vitamin E with selenium 15 min's after, wait another 15 min's and take the phenols. Repeat the pathway blockers and antioxidants a few hrs later. In between the celebrex dosage of 200mg B.I.D I take melatonin. It is also an anti inflammatory and free radical scavenger.
I have not heard of ulcers before. Thanks for sharing that side effect. I make my own toothpaste using baking soda, peppermint or spearment oil and rinse with coconut oil so maybe that is why I never had that. I also keep my hands and feet moisturized with a combo I make using olive oil or avocado oil with cocoa butter. My dogs go crazy wanting to eat it, lol.
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Jacques
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Re: Xeloda dosing

Postby Jacques » Sun Nov 20, 2022 9:08 am

Rock_Robster wrote:...
I’m avoiding added folate / folic acid and doing the topical treatments for the HFS (urea cream, etc) but wondering what peoples’ views on systemic treatments for side effects are that don’t interfere with efficacy? I’ve seen decent data for celebrex (celecoxib) which seems to be synergistic with Xeloda anyway so will restart that, but also hearing melatonin? I was taking 30-40mg nightly anyway but the onc pharmacist suggested I stop due to antioxidant effects on the Xeloda. Any thoughts welcome!

Cheers,
Rob


Rob - Thanks for starting this thread. This thread should eventually yield a lot of useful tips on how to deal effectively with the various Xeloda side effects, both proactively and retroactively.

I don't have much to contribute as far as systemic treatments for Xeloda side effects go. But I did notice an alert against using the oral steroid dexamethasone along with celebrex (celecoxib). Apparently, the two don't mix well:
"Using dexamethasone together with celecoxib may increase the risk of side effects in the gastrointestinal tract such as inflammation, bleeding, ulceration, and rarely, perforation. Gastrointestinal perforation is a potentially fatal condition and medical emergency where a hole forms all the way through the stomach or intestine. You should take these medications with food to lessen the risk. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. Your doctor may also be able to recommend medications to help protect the stomach and intestine if you are at high risk for developing serious gastrointestinal complications. You should seek immediate medical attention if you experience any unusual bleeding or bruising, or have other signs and symptoms of bleeding such as dizziness; lightheadedness; red or black, tarry stools; coughing up or vomiting fresh or dried blood that looks like coffee grounds; severe headache; and weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor."
Reference: https://www.medicine.com/interaction-checker/result?drugs=celecoxib+dexamethasone#interaction-drug

Apparently, oral dexamethasone is sometimes used to attenuate HFS symptoms, but if it is used, it must be used cautiously.

rp1954
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Re: Xeloda dosing

Postby rp1954 » Sun Nov 20, 2022 11:48 am

Yeah steroids are something we avoided for all 8 chemo years.

In most cases, through the use of IV vitamin C (IVC) for almost 12 years, and/or NSAIDs, usually celecoxib, post-surgically and chemo years, 2.7 ~ 9 (into post chemo time).

In our IVC circle, one woman (not a cancer patient) totally stopped her years long daily Prednisone requirements with IVC. Another broke his severe COVID storm fever with IV vitamin C, then got a lung infection later when dexamethasone was unnecessarily added (1st choice methylprednisolone was unavailable).

Other patients have long used IV vitamin C with various CRC chemo, especially Folfiri when they are wanting to quit.
I am not sure about current data on Avastin + celecoxib, definitely a review/research area for interactions and safety.

One of our starting points was the willingness to use IV vitamin C to reduce the need for Avastin because Vegf-A is mediated through histamine. Histamine is modulated by ascorbate on both sides of creation and destruction of histamine, to reduce histamine and VEGF-A levels. In 2010-2011, I looked at the possibility of extending Avastin and reduced Avastin total dose with IV ascorbate, but we never needed Avastin as it turned out. We didn't need celecoxib until 2012-13 because of the other inhibitors and improved 5FU (UFT) dosing with natural folate and oral leucovorin (LV for UFT but probably not Xeloda).

Working 5FU formulas are additive affairs to maintain chemosensitivity. Essentially, we were able to totally "trade" oxi-, iri- and Avastin for IVC, generic drugs and potent nutraceutical doses, on an individualized test basis, while still oxi-iri naive.

As for oral ulcers, from the earlier 5FU-folic acid toxicity era (3Q2010) and occasionally after, we used a powder blend of buffered ascorbates, glutamine, zinc carnosine, glucosamine and MK4 to hold as long as possible in the mouth or externally, swish and swallow to address GI integrity/injuries, too.
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper to almost nothing mid 2018, mostly IV C


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