Xeloda is a medicine that contains the active substance capecitabine. It is available as peach-coloured tablets (150 and 500 mg).
|Table of Contents|
|What is it used for?|
|How is it used?|
|How does it work?|
|How has it been studied?|
|What benefits has it shown during the studies?|
|What is the risk associated?|
|Why has it been approved?|
Xeloda is an anticancer medicine. It is used to treat:
- colon (large bowel) cancer. Xeloda is used with or without other anticancer medicines in patients who have had surgery for ?stage III? or ?Dukes? stage C? colon cancer;
- metastatic colorectal cancer (cancer of the large bowel that has spread to other parts of the body). Xeloda is used with or without other anticancer medicines;
- advanced gastric (stomach) cancer. Xeloda is used with other anticancer medicines, including a platinum-containing anticancer medicine such as cisplatin;
- locally advanced or metastatic breast cancer (breast cancer that has begun to spread to other parts of the body). Xeloda is used with docetaxel (another anticancer medicine) after treatment with anthracyclines (another type of anticancer medicine) has failed. It can also be used on its own when treatment with both anthracyclines and taxanes (another type of anticancer medicine) has failed or when repeat treatment with anthracyclines is not suitable for the patient. The medicine can only be obtained with a prescription.
Xeloda should only be prescribed by a doctor who is qualified in the use of anticancer medicines. Xeloda is taken twice a day at doses between 625 and 1,250 mg per square metre body surface area (calculated using the patient?s height and weight). The dose depends on the type of cancer being treated. The doctor will calculate the number of 150- and 500-mg tablets the patient needs to take. Xeloda tablets should be swallowed with water within the 30 minutes after a meal. Treatment is continued for six months after colon surgery. For other types of cancer, treatment is stopped if the disease gets worse or the patient cannot tolerate the treatment. Doses need to be adjusted for patients with liver or kidney disease and for patients who develop certain side effects. Full details are available in the Summary of Product Characteristics (also part of the EPAR).
The active substance in Xeloda, capecitabine, is a cytotoxic medicine (a medicine that kills cells that are dividing, such as cancer cells) that belongs to the group ?anti-metabolites?. Capecitabine is a ?prodrug? that is converted to 5-fluorouracil (5-FU) in the body, but more is converted in tumour cells than in normal tissues. It is taken as tablets, while 5-FU normally needs to be injected. 5-FU is an analogue of pyrimidine. Pyrimidine is part of the genetic material of cells (DNA and RNA). In the body, 5-FU takes the place of pyrimidine and interferes with the enzymes involved in making new DNA. As a result, it inhibits the growth of tumour cells and eventually kills them.
In colon cancer, Xeloda on its own has been compared with the combination of 5-FU and folinic acid (a medicine that enhances the effects of 5-FU) in 1,987 patients who had previously had surgery for their cancer.
In metastatic colorectal cancer, Xeloda taken on its own has been compared with the combination of 5-FU and folinic acid in two studies involving 1,207 patients. Xeloda has also been compared with the combination of 5-FU and folinic acid, both in combination with oxaliplatin (another anticancer medicine), in two studies: the first involved 2,035 patients who had not been treated before, and the second involved 627 patients who had failed previous treatment with irinotecan and a fluoropyrimidine (a group of anticancer medicines that includes 5-FU).
In advanced gastric cancer, Xeloda with cisplatin has been compared with a combination of 5-FU and cisplatin in one study involving 316 patients. The company also presented the results of a published study involving 1,002 patients, which compared the effects of Xeloda and 5-FU, taken in combination with platinum-containing medicines and epirubicin (another anticancer medicine). In locally advanced or metastatic breast cancer, Xeloda with docetaxel has been compared with docetaxel on its own in 511 women. Two smaller studies (238 patients) have also looked at the effectiveness of Xeloda after failure of treatment with taxanes and anthracyclines.
The main measures of effectiveness were the number of patients whose cancer responded to treatment, how long it took for the disease to progress, how long the patients remained disease-free or how long they survived.
In colon cancer, Xeloda was also as effective as 5-FU and folinic acid, with about two-thirds of the patients remaining disease-free throughout the 3.8 years of the study.
In metastatic colorectal cancer, Xeloda was as effective as the combination of 5-FU and folinic acid. When taken alone, between 19 and 25% of patients responded to Xeloda, and 12 to 15% responded to the comparator combination. When either Xeloda or 5-FU and folinic acid were taken with oxaliplatin, it took an average of eight months for the disease to get worse in patients who had not been treated before, and five months in patients whose previous treatment had failed.
In advanced gastric cancer, Xeloda with cisplatin was as effective as 5-FU and cisplatin. It took 5.6 months for the disease to get worse in patients taking Xeloda and cisplatin, and 5.0 months in patients receiving 5-FU and cisplatin. The published study showed that patients taking combinations of medicines that included Xeloda survived for a similar length of time as those taking combinations including 5-FU.
In locally advanced or metastatic breast cancer, Xeloda combined with docetaxel was more effective that docetaxel on its own in increasing how long it took for the disease to get worse (186 days compared with 128 days).
The most common side effects with Xeloda (seen in more than 1 patient in 10) are anorexia (loss of appetite), diarrhoea, vomiting, nausea (feeling sick), stomatitis (sores in the mouth), abdominal (tummy) pain, palmar-plantar erythrodysaesthesia syndrome (?hand-foot syndrome?, a skin reaction with rash and pain on the hands and feet), fatigue (tiredness) and asthenia (weakness). For the full list of all side effects reported with Xeloda, see the Package Leaflet.
Xeloda should not be used in people who may be hypersensitive (allergic) to capecitabine, to any of the other ingredients, or to fluorouracil. Xeloda should also not be used in the following groups:
- patients who have had severe and unexpected reactions to fluoropyrimidine therapy (a group of anticancer medicines);
- patients with dihydropyrimidine dehydrogenase deficiency (low levels of an enzyme);
- pregnant or breast-feeding women;
- patients with severe leucopenia, neutropenia, or thrombocytopenia (low levels of white cells or platelets in the blood);
- patients with severe liver or kidney disease;
- patients treated with sorivudine or similar anticancer medicines such as brivudine within the last four weeks.
The Committee for Medicinal Products for Human Use (CHMP) decided that Xeloda?s benefits are greater than its risks for:
- the adjuvant treatment of patients following surgery of stage III (Dukes? stage C) colon cancer;
- the treatment of metastatic colorectal cancer;
- first-line treatment of advanced gastric cancer in combination with a platinum-based regimen;
- the treatment of patients with locally advanced or metastatic breast cancer either in combination with docetaxel after failure of anthracycline chemotherapy, or as monotherapy after failure of both anthracycline and taxane chemotherapy or when further anthracycline therapy is not indicated. The Committee recommended that Xeloda be given marketing authorisation.