Xeloda is a new hope for patients with gastrointestinal tumors, and it is used for combined chemotherapy of advanced or metastatic colorectal cancer and advanced or metastatic gastric cancer.

Xeloda is also suitable for the further treatment of advanced primary or metastatic breast cancer that is ineffective to paclitaxel and chemotherapy.

Treatment classification: chemotherapy

Active ingredient: capecitabine

Indications:

Xeloda is suitable for the further treatment of advanced primary or metastatic breast cancer which is ineffective by paclitaxel and chemotherapy including anthracycline antibiotics. Dosage and usage:

Recommended dosage: 2500mg/m2 daily for two weeks, and the drug was stopped for one week. The total daily dose is taken twice with water in the morning and half an hour after meals. If the condition continues to deteriorate or produces unbearable toxicity, treatment should be stopped.

Dose adjustment during treatment:

The toxicity caused by Xeloda sometimes requires symptomatic treatment or dose adjustment (withdrawal or reduction). Once the dose is reduced, it can't be increased in the future. The following is the recommended dose after toxicity adjustment (according to the general toxicity standard set by the National Cancer Institute of Canada).

1 level.

Level two.

First appearance: stop the treatment until it returns to the level of 0- 1, and then proceed to the next course of treatment according to the maintenance dose of 100%.

The second appearance: stop the treatment until it returns to the level of 0- 1, and carry out the next course of treatment according to 75% of the maintenance dose.

The third appearance: stop the treatment until it returns to the level of 0- 1, and carry out the next course of treatment according to 50% of the maintenance dose.

The fourth manifestation: permanent cessation of treatment.

The third level:

First appearance: stop the treatment until it returns to the level of 0- 1, and then proceed to the next course of treatment according to 75% of the maintenance dose.

The second appearance: stop the treatment until it returns to the level of 0- 1, and carry out the next course of treatment according to 50% of the maintenance dose.

The third manifestation: permanent cessation of treatment.

Level 4:

Stop treatment permanently.

If it is necessary to continue treatment after drug withdrawal, the patient's interests should be maximized. When the toxic symptoms return to the level of 0- 1, 50% of the recommended dose should be used.

Dose adjustment for special population:

Hepatic insufficiency: Xeloda's pharmacokinetic study on patients with mild to moderate hepatic insufficiency caused by liver metastasis shows that such patients do not need dose adjustment.

Renal Insufficiency: Xeloda pharmacokinetics has not been studied in patients with renal insufficiency (referring to serum creatinine).

Children: The efficacy and safety of Xeloda have not been studied in children. Old people: no need to adjust the dose. However, capecitabine is more toxic to the elderly (over 65 years old) than to the young, so it should be closely monitored.

Contraindications: Xeloda has serious side effects or has a history of allergic reaction to fluorouracil (a metabolite of capecitabine).

Preventive measures:

Toxicity to be limited includes diarrhea, abdominal pain, nausea, gastritis and hand-foot syndrome. Nearly half of the patients treated with Xeloda will induce diarrhea, and those with severe diarrhea due to dehydration should be closely monitored and given rehydration treatment. Diarrhea 4-6 times a day or diarrhea at night is Grade 2, diarrhea 7-9 times a day or diarrhea with incontinence and malabsorption is Grade 3, diarrhea 10 times a day or diarrhea with naked eyes and intravenous rehydration is Grade 4. If grade 2, 3 or 4 diarrhea occurs, Xeloda should be stopped until the diarrhea stops or the number of diarrhea drops to 1 grade. The dosage of xeloda should be reduced after grade 3 or 4 diarrhea. Almost half of the patients who use Xeloda have hand-foot syndrome, but most of them are 1-2, and grade 3 syndrome is rare. Most of the side effects can disappear, although it is necessary to stop the drug temporarily or reduce the dose, but it is not necessary to stop the drug for a long time.

Pregnant and lactating women:

The clinical study of Xeloda has not been carried out in pregnant women, but it must be considered that if Xeloda is used in such patients, it may cause fetal damage. Animal experiments show that capecitabine can cause fetal death or malformation. These findings indicate that capecitabine derivatives also have this effect, so xeloda cannot be used in pregnant women. If Xeloda is used during pregnancy, or if pregnancy occurs during the use of Xeloda, the potential risk of fetal injury or teratogenesis must be considered. Women of childbearing age must take contraceptive measures when using Xeloda.

Although it is not known whether Xeloda can be secreted into breast milk, many drugs can be secreted into breast milk, which may cause serious side effects to nursing babies. Therefore, it is recommended that women who use Xeloda stop breastfeeding.

Side effects:

Xeloda has fewer side effects, which may be related to the following situations:

Digestive system: The most common side effects of Xeloda are reversible gastrointestinal reactions, such as diarrhea, nausea, vomiting, abdominal pain and gastritis.

Serious (grade 3-4) side effects are relatively few.

Skin: Almost half of Xeloda users have hand-foot syndrome: numbness, insensitivity, abnormal sensation, tingling, anodyne, skin swelling or erythema, desquamation, blisters or severe pain. Dermatitis and alopecia are common, but serious cases are rare.

General adverse reactions: fatigue is common, serious and rare. Other common side effects are mucositis, fever, weakness and lethargy, but they are not serious.

Nervous system: headache, paresthesia, taste disorder, dizziness and insomnia are common, and severe cases are rare.

Cardiovascular system: edema of lower limbs is mild and uncommon. No other cardiovascular side effects were observed.

Blood system: neutropenia is rare and not serious, and anemia is rare and not serious.

Others: anorexia and dehydration are common, and severe cases are rare.

Interaction:

Combination medication: Xeloda is combined with a large number of drugs, such as antihistamines, NSAIDs, morphine, paracetamol, aspirin, antiemetics, H2 receptor antagonists, etc. No clinically significant side effects were found.

Protein binding: Capecitabine has a low binding rate with serum protein (64%), and the possibility of drug interaction with energy protein through replacement is unpredictable.

Interaction with cytochrome P450 enzyme: Capecitabine has no effect on human liver microsomal P450 enzyme in vitro.

Drug overdose:

In the clinical trial of Xeloda, no side effects caused by drug overdose were found. However, in animal experiments (active treatment of monkeys at 25,679 mg/m2/day) and maximum tolerated dose treatment of human beings (3,565,438+0.4 mg/m2/day), the manifestations of drug overdose are nausea, vomiting, diarrhea, gastrointestinal irritation, gastrointestinal bleeding and bone marrow suppression. Treatment methods should include dehydration treatment with diuretics and dialysis treatment when necessary.

Save method:

Drugs should be stored at 15 ~ 25℃ in a dry place; If it goes bad or expires, it can't be eaten any more.