Capecitabine: Brands, Price & Uses in Bangladesh

Established / FDA-Approved Uses

• Metastatic breast cancer: Capecitabine monotherapy is indicated for patients whose disease is resistant to both paclitaxel and an anthracycline-containing chemotherapy regimen, or in patients for whom further anthracycline therapy is not indicated (e.g., patients who have already received cumulative doses of 400 mg/m² or more of doxorubicin or doxorubicin equivalents). Capecitabine is also indicated in combination with docetaxel for treatment of metastatic breast cancer after failure of prior anthracycline-containing chemotherapy.
• Colon cancer (adjuvant treatment): Capecitabine is indicated as a single agent for adjuvant treatment of Dukes' C colon cancer in patients who have undergone complete resection of the primary tumor, when treatment with fluoropyrimidine therapy alone is preferred.
• Metastatic colorectal cancer: Capecitabine is indicated as first-line treatment of metastatic colorectal cancer, alone or in combination with other chemotherapy agents, when treatment with a fluoropyrimidine alone is preferred.

Guideline-Supported / Combination Uses

• Used as part of combination chemotherapy regimens (e.g., with oxaliplatin, commonly referred to as CAPOX/XELOX) for colorectal cancer, based on oncology treatment guidelines.
• Used off-label, under oncologist supervision, as part of guideline-directed combination regimens in other gastrointestinal, gastric, and pancreatic cancers.

Capecitabine is a cytotoxic chemotherapy medicine and must only be prescribed and monitored by a qualified oncologist or physician experienced in cancer chemotherapy.

Metastatic Breast Cancer (Monotherapy)

1250 mg/m² taken orally twice daily (total 2500 mg/m²/day) for 14 days, followed by a 7-day rest period, given as repeated 21-day cycles, continued until disease progression or unacceptable toxicity.

Metastatic Breast Cancer (with Docetaxel)

Capecitabine 1250 mg/m² twice daily on Days 1–14 of a 21-day cycle, combined with docetaxel 75 mg/m² intravenously on Day 1 of the same cycle.

Colon Cancer (Adjuvant, Dukes' C)

1250 mg/m² twice daily for 14 days followed by a 7-day rest period, given as 21-day cycles, for a total of 8 cycles (24 weeks).

Metastatic Colorectal Cancer

1250 mg/m² twice daily for 14 days followed by a 7-day rest, as 21-day cycles, either as monotherapy or in combination with other approved chemotherapy agents per oncologist-directed protocol.

Renal Impairment

No dose adjustment is needed in mild renal impairment (creatinine clearance 51–80 mL/min). In moderate renal impairment (creatinine clearance 30–50 mL/min), a dose reduction to 75% of the standard dose is recommended. Capecitabine is contraindicated in patients with severe renal impairment (creatinine clearance below 30 mL/min).

Hepatic Impairment

Close monitoring is recommended in patients with mild to moderate hepatic dysfunction due to liver metastases; Capecitabine has not been studied in patients with severe hepatic impairment.

Dose modifications or interruptions may be required for hematologic, gastrointestinal, dermatologic (e.g., hand-foot syndrome), or other toxicities, as directed by the treating oncologist.

Very Common / Common

• Diarrhea (can be severe and cause dehydration)
• Hand-foot syndrome (palmar-plantar erythrodysesthesia) — redness, swelling, pain, and peeling of the palms and soles; a notable, dose-limiting toxicity of Capecitabine
• Nausea and vomiting
• Stomatitis (mouth sores) and abdominal pain
• Fatigue and weakness
• Loss of appetite

Serious / Less Common

• Myelosuppression: neutropenia, anemia, thrombocytopenia (increased risk of infection and bleeding)
• Cardiotoxicity: chest pain/angina, arrhythmias, and rarely myocardial infarction
• Severe skin reactions and mucositis
• Hyperbilirubinemia and liver enzyme abnormalities
• Eye irritation, excessive tearing, or corneal changes with prolonged use

Patients should seek prompt medical attention for severe or persistent diarrhea, fever, signs of infection, unusual bleeding or bruising, or severe hand-foot symptoms.