Toxicity associated with capecitabine plus oxaliplatin in colorectal cancer before and after an institutional policy of capecitabine dose reduction

Abstract

Background:Capecitabine plus oxaliplatin (CAPOX) is an established treatment option in colorectal cancer, but can be associated with severe toxicities.Methods:Following reporting of severe diarrhoea and dehydration with capecitabine 2000 mg m-2 per day plus oxaliplatin every 3 weeks (CAPOX 2000) in 2006, we instituted a policy change to reduce capecitabine dose to 1700 mg m-2 per day (CAPOX 1700). We undertook a retrospective analysis comparing toxicities encountered before and after this dose change.Results:Of the 400 patients treated, no significant differences were seen between the CAPOX 2000 and CAPOX 1700 in grades 3 and 4 diarrhoea (21% vs 19%; P0.80), stomatitis (0% vs 1%; P0.50) or grades 2-4 hand foot syndrome (16% vs 11%; P0.18). Grades 3 and 4 neutropenia (9.5% vs 3.5%; P0.03) and all grades hyperbilirubinaemia (60% vs 40%; P0.0001) were significantly reduced with CAPOX 1700. Rates of hospitalisation due to toxicities were not different between two groups (13% vs 11%; P0.53).Conclusions:No clinically or statistically significant differences in gastrointestinal toxicities or hospitalisation rate were seen after reducing our routine capecitabine dose from CAPOX 2000 to CAPOX 1700. © 2011 Cancer Research UK All rights reserved.