Clinical Medicine Reviews in Oncology

Capecitabine is an oral pro-drug of 5-fluorouracil (5FU) that has demonstrated an efficacy at least equivalent to standard leucovorin (LV)-modulated 5FU I.V. bolus regimen in the management of metastatic colorectal cancer (MCRC) patients as well as in the adjuvant setting. Despite a mild increase of some side effects, capecitabine is usually better tolerated than 5FU/LV, and could be preferable in the treatment of elderly patients. Moreover, usually the patients compliance with an oral treatment is better than with a regimen requiring the placement of a central venous catheter and infusional devices. The combination of capecitabine with oxaliplatin (XELOX regimen) was shown to be as effective as the combination of 5FU/LV with oxaliplatin (FOLFOX4 regimen) in MCRC. The XELOX regimen represents now a new standard of care for MCRC patients, and it will be probably considered in the next future an “user-friendly” alternative to the FOLFOX4 also in resected patients. The addition of bevacizumab to the XELOX regimen was demonstrated to further prolong the progression-free survival of metastatic patients, and is anticipated to reduce the risk of recurrence in resected colon cancer. Despite a higher acquisition cost than 5FU/LV, capecitabine is also cost-effective, because of the reduced costs for drug administration and management of adverse events.