Capecitabine

INTRODUCTION

Indications

Metastatic colorectal cancer. Adjuvant treatment for Dukes' C colon cancer following primary resection. Metastatic breast cancer that has worsened despite prior therapy with anthracycline (daunorubicin, doxorubicin, idarubicin) (to be used in combination with docetaxel). Metastatic breast cancer that is resistant to both paclitaxel and an anthracycline (daunorubicin, doxorubicin, idarubicin) or is resistant to paclitaxel and further anthracycline therapy is contraindicated.

Action

Converted in tissue to 5-fluorouracil (5-FU), which inhibits DNA and RNA synthesis by preventing thymidine production. The enzyme responsible for the final step in the conversion to 5-FU may be found in higher concentrations in some tumors. Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

Adverse Reactions/Side Effects

CNS: fatigue, headache, dizziness, insomnia. EENT: eye irritation, epistaxis, rhinorrhea. CV: edema, chest pain. GI: DIARRHEA, NECROTIZING ENTEROCOLITIS, abdominal pain, anorexia, constipation, dysgeusia, hyperbilirubinemia, nausea, stomatitis, vomiting, dyspepsia, xerostomia. Derm: dermatitis, hand-and-foot syndrome, nail disorder, alopecia, erythema, rashes. F and E: dehydration. Hemat: anemia, leukopenia, thrombocytopenia. MS: arthralgia, myalgia. Neuro: peripheral neuropathy. Resp: cough, dyspnea. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of severe intestinal infection and inflammation that might indicate necrotizing enterocolitis. Signs include vomiting, constipation, tarry or bloody stools, unstable body temperature, lack of appetite, and a swollen, red, tender, or shiny abdomen. Report these signs to the physician or nursing staff immediately.

• Monitor and report other GI reactions, including severe diarrhea.

• Monitor signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to anemia. Report these signs to the physician immediately.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Assess any breathing problems, and report difficult/labored breathing or a persistent cough.

• Assess signs of peripheral neuropathy such as numbness, tingling, and decreased muscle strength. Establish baseline electroneuromyographic values using EMG and nerve conduction at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

• Assess any muscle or joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against ...