Xeloda for Metastatic Breast Cancer

An oral chemotherapy option

Xeloda (capecitabine) is an oral chemotherapy drug approved by the U.S. Food and Drug Administration (FDA) to treat metastatic breast cancer in people who have not responded to medications like Taxol (paclitaxel), Taxotere (docetaxel), Adriamycin (doxorubicin), or anthracycline-containing chemotherapy options. Xeloda can be given alone or with other drugs.

Young female cancer patient meets with doctor
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Indications

If you have already been treated with Taxol (paclitaxel) and Adriamycin (doxorubicin) for stage 4 (metastatic) breast cancer and had no response, your doctor may recommend that you take Xeloda by itself.

If you have had no response from treatment with anthracyclines, your doctor may instead recommend that you take Xeloda and Taxotere.

In addition to metastatic breast cancer, Xeloda is used to treat metastatic colon, rectal, and prostate cancers.

How It Works

Xeloda kills cancer cells by imitating part of a cancer cell's genes. This makes the cell die before it can divide, which slows or stops cancer from growing. It is classified as an antimetabolite.

Efficacy

Studies show this drug appears to:

  • Xeloda may prolong both overall survival and disease-free survival in people with metastatic HER2-negative breast cancer, as a post-surgical treatment
  • In combination with Tykerb (lapatinib), improve overall survival and progression-free survival in HER2-positive breast cancer that has progressed on Herceptin (trastuzumab)
  • In combination with Tykerb, improve HER2-positive breast cancer that has metastasized to the brain, when local therapy isn't effective and re-irradiation isn't feasible
  • In combination with standard chemotherapy, improve overall survival and disease-free survival in triple-negative breast cancer (although studies are mixed on this point)

While studies show that it can be effective for many people, Xeloda may not be as effective as some other drugs, and adding it to other chemotherapy drugs may increase the risk of side effects.

Dosage and Administration

Xeloda is an oblong, peach-colored pill given in either 150 milligram (mg) or 500 mg dosages. It's generally taken twice a day, ideally about 30 minutes after a meal and with plenty of water.

The pills should not be crushed, chewed, or dissolved. If you miss a dose, you should wait until your next dose is due and take only that. You should not take an extra dose to compensate for the missed dose.

It's taken on a cyclical dosage schedule that's two weeks on, one week off, then two weeks on. Your doctor will decide how long you'll stay on this cycle.

Side Effects

Common side effects of Xeloda include:

  • Diarrhea
  • Nausea
  • Vomiting
  • Oral mucositis (sores in your mouth, tongue, and throat)
  • Stomach pain
  • Low appetite
  • Dehydration
  • Skin rash or dry, itchy skin
  • Dizziness
  • Fatigue
  • Headache
  • Swelling of the feet, ankles, or hands
  • Neuropathy (tingling of fingers and toes)

When taking Xeloda, try to stay hydrated by drinking more water than you are used to. Doctors often recommend you drink two to three quarts of water every 24 hours. You may be told to skip alcohol or caffeine, as these can dehydrate you. If you experience mouth or tongue sores, replace your usual toothbrush with a soft-bristled kind. There are also many other measures as well as food choices you can make to reduce this symptom.

If you experience dizziness, plan to take it easy when you're taking Xeloda. If you're extremely nauseous, your doctor may recommend anti-nausea medications to help you through.

The side effects of Xeloda may be different if you are taking it along with Taxotere or other chemotherapy drugs. Be sure to report all of your side effects to your doctor. Note the dates and times they occur, and rank the severity of each symptom.

Call your doctor and stop taking Xeloda immediately if you have these symptoms:

  • Severe diarrhea
  • Severe vomiting
  • Painful sores in your mouth and tongue
  • Fever

Risks

If you use Coumadin (warfarin), or other blood thinning medications, Xeloda can cause your blood to thin more, putting you in danger of extensive bleeding. Tell your doctor if you take any blood thinner. You may need to take a lower dose of Xeloda. It's important to note that some nutritional supplements may also work as blood thinners, and you should talk to your oncologist before taking any of these preparations.

If you are 80 years old or older, Xeloda may cause more diarrhea, nausea, and vomiting than in younger people.

Common cuts are more complicated when you take Xeloda, so it's important to minimize the risk of getting a cut. Doctors usually recommend you switch to an electric razor for shaving for this reason. It's also a good idea to wear gloves, both the protect your hands while doing housework, and when going outside in cool weather. The risk of hand-foot syndrome also requires careful care of your feet such as wearing good shoes (not going barefoot).

In addition, you may find yourself feeling more susceptible to sunlight while on this drug. Avoid sun exposure and use a good sunscreen whenever you are outside. Since some sunscreens are ineffective when combined with cancer treatment, covering up (using UV clothes and an umbrella, for example), are the ideal way to protect your skin.

Since Xeloda can make you more susceptible to infections, you should avoid situations that might put you at risk, such as crowded places and visiting ill friends.

Contraindications

You should not take Xeloda if:

  • You are allergic to 5-fluorouracil (5-FU)
  • You have kidney or liver problems
  • You are breastfeeding
  • You are pregnant or may become pregnant

In addition, about 1 in 20 people have specific liver metabolism enzymes that lead to a slower breakdown of the drug. These people can have significant side effects like severe diarrhea and extensive palmar-plantar erythrodysesthesia, which includes sores on the palms and feet. These people should not take Xeloda.

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Article Sources
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