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Capecitabine versus 5-FU in metastatic colorectal cancer: considerations for treatment decision-making
Arizona Oncology Associates (US Oncology), Sedona, AZ
Advances in the therapy of metastatic colorectal cancer are expanding the therapeutic options available for patients who once had limited treatment choices. Some new approaches are minimizing the risk of complications and drug-induced reactions without sacrificing therapeutic benefit. Among these approaches is a return to the oral route of administration for selected antineoplastic agents, such as capecitabine, an oral fluoropyrimidine. The oral approach is preferred by patients because it is more convenient, resulting in fewer medical office visits, and less uncomfortable, as no intravenous access is required. Clinicians also prefer this approach because it eliminates the risk of complications, such as infection and clotting associated with venous access devices and infusion pumps. In addition, recent trial findings indicate that the side-effect profile of capecitabine differs from its predecessor, bolus 5-flourouracil—a lower incidence of myelosuppression, mucositis, and diarrhea, but more hand-foot syndrome, as with infusional 5-FU, which capecitabine mimics. In redefining clinical care to integrate oral cancer therapy, clinicians are developing new programs and interventions to ensure patient compliance, minimizing symptoms, creative distance-monitoring capabilities, and maximizing reimbursement for self-administered therapies. This paper provides an overview of colorectal cancer, discusses capecitabine, and proposes a patient-management action plan for office practices comprising three parts: initial assessment and monitoring, patient education, and side-effect management.
| Commun Oncol 2006;3:19–27 | full text |  188 kb |