Capecitabine is a chemotherapy drug that is taken as tablets.
Before starting your treatment many hospitals will arrange a chemotherapy information session. At this appointment a nurse will discuss how and when your chemotherapy will be given and how side effects can be managed. Contact numbers will also be given so you know who to phone if you have any questions or concerns.
Who might be offered capecitabine?
Capecitabine is used to treat breast cancer that has come back after previous treatment and has spread to areas around the breast, such as the lymph nodes above or below the collarbone (locally advanced breast cancer also known as regional recurrence), or to other parts of the body (secondary breast cancer). It’s often given on its own, but can also be given alongside other drugs used to treat breast cancer.
Capecitabine may also be offered as part of a clinical trial. Clinical trials are research studies that aim to improve treatment or care. Visit www.cancerresearch.org.uk for listings of current UK trials.
How does capecitabine work?
Chemotherapy is treatment aimed at destroying cancer cells using anti-cancer drugs, which are also called cytotoxic drugs. Chemotherapy drugs work by interrupting how cancer cells develop and grow. Different drugs do this at different stages of cell development.
Capecitabine is taken as tablets and moves through the digestive system into the bloodstream. The drug travels throughout the body, via the bloodstream, to various cells including the breast cancer cells, where it is converted into the chemotherapy drug 5 fluorouracil (also known as 5FU).
As capecitabine is converted into 5FU more efficiently in cancer cells, it means that there are fewer side effects on normal cells.
How is capecitabine taken?
Like other chemotherapy drugs, capecitabine is taken in cycles. Your specialist will prescribe a dose and regime that is appropriate for you.
Capecitabine is available in two different tablet strengths: 150mg or 500mg. You will be told how many of each tablet to take to make sure you get the right amount each day for your body size. You will usually take the capecitabine tablets twice a day (in the morning and evening) for 14 days and then have a seven-day break from taking the tablets. This 21-day period is one treatment cycle. You should swallow the tablets with water within half an hour of eating a meal.
What happens if I miss a dose?
If you miss a dose of capecitabine, do not take an extra dose to make up for the one you missed. Keep to your usual amount and speak to someone in your treatment team.
How long will I have to take capecitabine for?
This will vary from person to person. Usually people keep taking capecitabine until it is no longer helping to control the cancer or they are experiencing significant side effects. Your specialist will talk to you about what is best for you.
What are the possible side effects of capecitabine?
Like any treatment, capecitabine can cause side effects. Everyone reacts differently to drugs and some people experience more side effects than others. These side effects can usually be controlled and those described here will not affect everyone.
Common side effects of capecitabine
Diarrhoea is common during treatment, and sometimes this can be severe. Tell your chemotherapy nurse or specialist as they can prescribe medication and consider stopping your capecitabine for a time to help control it. It’s particularly important to speak to them immediately if you have any of the following symptoms:
- four or more episodes of diarrhoea in 24 hours
- blood in your stools when you go to the toilet
- abdominal pain.
Hand-foot (palmar plantar) syndrome
The palms of the hands and the soles of the feet can become red and sore. Sometimes you may also notice a tingling sensation, numbness or some swelling. Your doctor can prescribe vitamin B6 (pyridoxine) which might help with this.
Your skin may also become red, dry and flaky. This should improve if the treatment is delayed or if the dose is reduced. Using a glycerine-based moisturising cream can also help.
If you experience skin reactions, mention this to your specialist when you see them next so that the symptoms can be managed.
Feeling sick and vomiting
Sometimes you can feel sick during your treatment. Although most people will not actually be sick, anti-sickness drugs can help reduce or stop this happening, so take these as prescribed.
Effects on the blood
Capecitabine, like most chemotherapy drugs, can temporarily affect the number of healthy blood cells in the body. Blood cells (white blood cells, red blood cells and platelets) are released by the bone marrow (the spongy material found in the hollow part of bones) to replace those which are naturally used up in the body. Chemotherapy reduces the ability of the bone marrow to make these cells.
You will have regular blood tests throughout your treatment to check your blood count. If the number of blood cells is too low it may be necessary to delay the next course of treatment or reduce the dose of the chemotherapy you are given.
Risk of infection
Not having enough white blood cells can increase the risk of getting an infection. The number of white blood cells usually returns to normal before your next course of chemotherapy is due. When the white blood cells fall below a certain level, it is known as neutropenia. If you also have a high temperature (above 38°C), it’s known as febrile neutropenia
If you feel unwell, develop a sore throat or shivering or have a temperature above 38°C at any time during your treatment, you should contact the hospital immediately, even if this happens at the weekend or during the night.
Before starting chemotherapy you should be given a 24-hour contact number or told where to get emergency care by your specialist team. You may need antibiotics. Sometimes your doctor may recommend injections of drugs called growth factors to stimulate the production of white blood cells to reduce your risk of infection.
Having too few red blood cells can mean you are anaemic. If you feel particularly tired, breathless or dizzy, you should let your specialist team know. Occasionally a blood transfusion will be necessary during your treatment.
Bruising and bleeding
Capecitabine can reduce the number of platelets (which help the blood to clot). You may bruise more easily, have nosebleeds or your gums can bleed when you brush your teeth. Tell your specialist team if you experience any of these symptoms.
Hair loss (alopecia)
When used on its own, capecitabine occasionally causes some temporary hair thinning. It very rarely causes complete hair loss. If capecitabine is taken in combination with other chemotherapy drugs, for example docetaxel, most people will lose all their hair including eyebrows, eyelashes and body hair. If you would like further information, see our booklet Breast cancer and hair loss.
Loss of appetite
You can lose your appetite while taking capecitabine. Talk to your specialist about this. They will give you advice and information to help deal with loss of appetite, or refer you to a dietitian if needed.
Driving and using machinery
Capecitabine may make you feel dizzy, sick or tired, so could possibly affect your ability to drive or operate machinery safely. Avoid driving or using machinery if you have any symptoms that may affect your ability to do this.
Rare side effects
Very occasionally allergic reactions to a drug can occur. Reactions can vary from mild to severe, although severe reactions are uncommon. If you have any swelling, wheezing, chest pain or difficulty breathing after taking capecitabine, let your specialist or chemotherapy nurse know immediately.
Some other side effects of capecitabine are similar to other chemotherapy drugs. These include:
- sore mouth
- tiredness (fatigue)
- sore eyes and runny nose
- effects on fertility.
If you are concerned about side effects, regardless of whether they are listed here, talk to your chemotherapy nurse or cancer specialist (oncologist) as soon as possible.
If you have secondary breast cancer, you can read our tips on managing fatigue.
Can I take capecitabine with other drugs?
Tell your specialist about any other drugs or supplements you are taking.
If you take drugs to thin the blood (anti-coagulants) such as warfarin, capecitabine can increase your risk of bleeding. Your specialist may check more often how fast your blood clots, adjust your dose of blood-thinning drugs or more commonly change you to an injection to thin the blood instead of warfarin.
Can I get pregnant when taking capecitabine?
Taking capecitabine while pregnant may have a harmful effect on a developing baby. Some women can still become pregnant even if their periods are irregular or have stopped, so effective barrier contraception such as a condom should be used.