Breast cancer occurs when cells in the breast begin to grow uncontrollably. Malignant breast cancer — both invasive and non-invasive — was diagnosed in about 291,000 women and 2,350 men in 2015 in the U.S., according to the American Breast Cancer Foundation. It causes symptoms like a new breast lump or mass, swelling of all or part of a breast, skin irritation or dimpling, breast or nipple pain, nipple retraction, redness, scaliness, or thickening of the nipple or breast skin, and nipple discharge other than breast milk.
Surgery and radiation therapy for breast cancer are classified as local treatments since they are focused on treating the cancer without harming the rest of the body, while systemic treatments, like chemotherapy, hormone therapy, targeted therapy, and bone-directed therapy, are focused on the use of drugs to reach and destroy cancer cells in the body.
How Capecitabine (Xeloda) Works
The chemotherapy drug capecitabine is included in a group of drugs known as anti-metabolites. This group is focused on stopping the formation of new cancer cells and disrupting the DNA repair process, which is how cancer cells are able to grow and multiply. Capecitabine is used for the treatment of a number of cancers, including the breast, bowel, stomach, pancreas, and esophagus.
It is administered orally in the form of tablets, which are usually taken twice a day with plenty of water. The dosage is defined according the characteristics of both tumor and patient, but the treatment usually consist of several cycles. After being ingested, the body transforms capecitabine tablets into the common chemotherapy drug fluorouracil.
“Fluorouracil (FU) is an antimetabolite with activity against numerous types of neoplasms, including those of the breast, esophagus, larynx, and gastrointestinal and genitourinary tracts. Systemic toxicity, including neutropenia, stomatitis, and diarrhea, often occur due to cytotoxic nonselectivity. Capecitabine was developed as a prodrug of FU, with the goal of improving tolerability and intratumor drug concentrations through tumor-specific conversion to the active drug,” explain the authors of the study “Capecitabine: a review,” about the drug’s mechanism of action. “Capecitabine is an oral prodrug that is converted to its only active metabolite, FU, by thymidine phosphorylase. Higher levels of this enzyme are found in several tumors and the liver, compared with normal healthy tissue.”
Capecitabine (Xeloda) to Treat Breast Cancer
The chemotherapy drug capecitabine was approved by the U.S. Food and Drug Administration (FDA) on June 15, 2005, and it is commercialized under the brand name Xeloda by Hoffman-LaRoche. The approval of capecitabine was based on clinical studies that demonstrated non-inferiority in disease-free survival, and the drug is now indicated for patients who suffer from breast cancer that has metastasized to other parts of the body. The median progression-free survival for breast cancer patients treated with the standard dosage of capecitabine is 4.3 months, as reported in the study “Efficacy of Very-Low-Dose Capecitabine in Metastatic Breast Cancer.”
Treatment with capecitabine can cause side effects. The most common, which occur in more than 10 percent of the patients, include increased risk of infection related to low white blood cells, tiredness, and breathlessness due to a drop in red blood cells (anemia), easily bruising due to low platelets, fatigue during and after the treatment, diarrhea, mouth ulcers, feeling or being sick, and soreness, redness, or peeling on the palms of the hands and soles of the feet.
In addition, between 1 and 10 percent of the patients experience constipation, headaches, and dizziness, eye problems, hair loss or hair thinning, abdominal pain, loss of appetite, high levels of bilirubin in the blood, amenorrhea, and loss of fertility. Side effects such as swollen ankles or chest pain happen in fewer than 1 percent of the patients.
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