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Colorectal metastatic capecitabine

This protocol was published over 10 years ago and has been assessed by the reference committee as suitable to be reviewed as required. The review due date has been removed. If something in this protocol requires reference committee consideration, please click on the feedback button at the bottom of the page.

Read more about the as required review process in this factsheet.

 Fluoropyrimidine overdose or overexposure:

Fluoropyrimidine overdose or overexposure may result in severe or life-threatening toxicity. An antidote is available and is highly effective if given within 96 hours.  Read more about fluoropyrimidine overdose or overexposure.

Check for clinical trials in this patient group. Link to Australian Clinical Trials website

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Cycle 1 and further cycles

Drug Dose Route Day
Capecitabine 1,250 mg/m2 TWICE a day * PO 1 to 14

* Consider starting capecitabine at a dose of 1000 mg/m2 BD in elderly patients and patients considered at risk of toxicity. Dosing may require rounding to the nearest tablet strength to enable delivery of a measurable dose.

Frequency:
21 days 
Cycles:
Continuous until disease progression or unacceptable toxicity
Drug status:

Capecitabine in on the PBS general schedule

Capecitabine is available as 150 mg and 500 mg tablets

Cost:
~ $90 per cycle "How this cost is calculated"

The cost displayed on the protocol is intended as rudimentary guide only for the Australian context.

The cost includes anti-cancer drugs only (not antiemetics, supportive medications or consumables), unless otherwise indicated.

Drug unit costs are taken directly from the Pharmaceutical Benefits Scheme (PBS) website (www.pbs.gov.au). These costs are reviewed and updated on eviQ at 6 monthly intervals. Anti-cancer drugs that are not included on the PBS do not have a cost included in eviQ protocols.

Where there are differing unit costs based on vial sizes and tablet strengths, the mean unit cost is used. The cost of oral continuous therapy is based on a 28 day month.

Where oral drugs are available on the PBS for both 30- and 60-day prescriptions, the unit cost for the 30-day supply is used.

The protocol cost is derived from drug dose calculations based upon a default body surface area (BSA) of 1.8 m2; weight of 75 kg; and creatinine clearance of 75 mL/min.

One off loading doses and ongoing maintenance doses are not included in protocol cost calculations.

The cost displayed is the actual drug cost and does not necessarily reflect the cost incurred by the patient as many anti-cancer drugs are reimbursed on the PBS.

The supportive therapies (e.g. antiemetics, premedications, etc.), infusion times, diluents, volumes and routes of administration, if included, are listed as defaults. They may vary between institutions and can be substituted to reflect individual institutional policy.

Antiemetics if included in the treatment schedule are based upon recommendations from national and international guidelines. These are defaults only and may be substituted to reflect individual institutional policy. Select here for recommended doses of alternative antiemetics.

Cycle 1 and further cycles

Day 1 to 14
Capecitabine 1,250 mg/m2 (PO) TWICE a day within 30 minutes after the end of a meal.*

* Dosing may require rounding to the nearest tablet strength to enable delivery of a measurable dose.

Frequency:
21 days 
Cycles:
Continuous until disease progression or unacceptable toxicity

Cycle 1 and further cycles

Drug Dose Route Day
Capecitabine 1,250 mg/m2 TWICE a day * PO 1 to 14

* Consider starting capecitabine at a dose of 1000 mg/m2 BD in elderly patients and patients considered at risk of toxicity. Dosing may require rounding to the nearest tablet strength to enable delivery of a measurable dose.

Frequency:
21 days 
Cycles:
Continuous until disease progression or unacceptable toxicity
Drug status:

Capecitabine in on the PBS general schedule

Capecitabine is available as 150 mg and 500 mg tablets

Cost:
~ $90 per cycle "How this cost is calculated"

The cost displayed on the protocol is intended as rudimentary guide only for the Australian context.

The cost includes anti-cancer drugs only (not antiemetics, supportive medications or consumables), unless otherwise indicated.

Drug unit costs are taken directly from the Pharmaceutical Benefits Scheme (PBS) website (www.pbs.gov.au). These costs are reviewed and updated on eviQ at 6 monthly intervals. Anti-cancer drugs that are not included on the PBS do not have a cost included in eviQ protocols.

Where there are differing unit costs based on vial sizes and tablet strengths, the mean unit cost is used. The cost of oral continuous therapy is based on a 28 day month.

Where oral drugs are available on the PBS for both 30- and 60-day prescriptions, the unit cost for the 30-day supply is used.

The protocol cost is derived from drug dose calculations based upon a default body surface area (BSA) of 1.8 m2; weight of 75 kg; and creatinine clearance of 75 mL/min.

One off loading doses and ongoing maintenance doses are not included in protocol cost calculations.

The cost displayed is the actual drug cost and does not necessarily reflect the cost incurred by the patient as many anti-cancer drugs are reimbursed on the PBS.

The supportive therapies (e.g. antiemetics, premedications, etc.), infusion times, diluents, volumes and routes of administration, if included, are listed as defaults. They may vary between institutions and can be substituted to reflect individual institutional policy.

Antiemetics if included in the treatment schedule are based upon recommendations from national and international guidelines. These are defaults only and may be substituted to reflect individual institutional policy. Select here for recommended doses of alternative antiemetics.

Cycle 1 and further cycles

Day 1 to 14
Capecitabine 1,250 mg/m2 (PO) TWICE a day within 30 minutes after the end of a meal.*

* Dosing may require rounding to the nearest tablet strength to enable delivery of a measurable dose.

Frequency:
21 days 
Cycles:
Continuous until disease progression or unacceptable toxicity
  • Advanced or metastatic colorectal cancer.
Safety alert fluoropyrimidines

Fluoropyrimidines can be administered by different routes and schedules with each method having associated increased risk of certain side effects. Fluoropyrimidine overdose or overexposure is a rare but potentially life threatening side effect of this drug class and can occur by any route of administration. An antidote is available and highly effective if given within 96 hours.

Read more about the medication safety alert for infusional fluorouracil and fluoropyrimidine overdose or overexposure
Caution with oral anti-cancer drugs

Select links for information on the safe prescribing, dispensing and administration of orally administered anti-cancer drugs. 

Read more about the Cancer Council Australia guidelines and oral anti-cancer therapy
Emetogenicity minimal or low

No routine prophylaxis required. If patients experience nausea and/or vomiting, consider using the low emetogenic risk regimen.

Read more about preventing anti-cancer therapy induced nausea and vomiting
Cardiac toxicity

Angina-like chest pain, tachycardia, arrhythmias, heart failure, myocardial infarction and cardiac arrest may occur with capecitabine especially in patients with a prior history of coronary artery disease.

Cardiac symptoms may require cessation of capecitabine and referral to a cardiologist for symptomatic treatment. Re-challenge is controversial and generally not recommended.

Read more about cardiac toxicity associated with anti-cancer drugs
Dihydropyrimidine dehydrogenase (DPD) enzyme deficiency

Rare, life-threatening toxicities such as mucositis, neutropenia, neurotoxicity and diarrhoea have been reported following administration of fluoropyrimidines (e.g. fluorouracil and capecitabine). Severe unexplained toxicities require investigation prior to continuing with treatment. Testing for DPD enzyme deficiency is available in Australia but not currently reimbursed.

Read more about dihydropyrimidine dehydrogenase (DPD) enzyme deficiency
Diarrhoea

Antidiarrhoeals (e.g. loperamide) are usually prescribed with this treatment.

Read more about treatment induced diarrhoea
Hyperbilirubinaemia

Capecitabine can induce hyperbilirubinaemia which may require an interruption in treatment (see dose modifications).
Blood tests

FBC, EUC, eGFR and LFTs at baseline and prior to each cycle.
Hepatitis B screening and prophylaxis

Routine screening for HBsAg and anti-HBc is NOT usually recommended for patients receiving this treatment.

Read more about hepatitis B screening and prophylaxis in cancer patients requiring cytotoxic and/or immunosuppressive therapy
Vaccinations

Live vaccines are contraindicated in cancer patients receiving immunosuppressive therapy and/or who have poorly controlled malignant disease.

Refer to the recommended schedule of vaccination for immunocompromised patients, as outlined in the Australian Immunisation Handbook.

Read more about COVID-19 vaccines and cancer.
Fertility, pregnancy and lactation

Cancer treatment can have harmful effects on fertility and this should be discussed with all patients of reproductive potential prior to commencing treatment. There is a risk of foetal harm in pregnant women. A pregnancy test should be considered prior to initiating treatment in females of reproductive potential if sexually active. It is important that all patients of reproductive potential use effective contraception whilst on therapy and after treatment finishes. Effective contraception methods and adequate contraception timeframe should be discussed with all patients of reproductive potential. Possibility of infant risk should be discussed with breastfeeding patients.

Read more about the impact of cancer treatment on fertility
Evidence for dose modifications is limited, and the recommendations made on eviQ are intended as a guide only. They are generally conservative with an emphasis on safety. Any dose modification should be based on clinical judgement, and the individual patient’s situation including but not limited to treatment intent (curative vs palliative), the anti-cancer regimen (single versus combination therapy versus chemotherapy versus immunotherapy), biology of the cancer (site, size, mutations, metastases), other treatment related side effects, additional co-morbidities, performance status and patient preferences.Suggested dose modifications are based on clinical trial findings, product information, published guidelines and reference committee consensus . The dose reduction applies to each individual dose and not to the total number of days or duration of treatment cycle unless stated otherwise. Non-haematological gradings are based on Common Terminology Criteria for Adverse Events (CTCAE) unless otherwise specified. Renal and hepatic dose modifications have been standardised where possible. For more information see dosing considerations & disclaimer.

Note: All dose reductions are calculated as a percentage of the starting dose.

Haematological toxicity
ANC x 109/L (pre-treatment blood test)
1.0 to less than 1.5 Refer to local institutional guidelines; it is the view of the expert clinicians that treatment should continue if patient is clinically well
0.5 to less than 1.0 Delay treatment until recovery
less than 0.5 Delay treatment until recovery and reduce capecitabine by 25% for subsequent cycles
Febrile neutropenia Delay treatment until recovery and reduce capecitabine by 25% for subsequent cycles
Platelets x 109/L (pre-treatment blood test)
75 to less than 100 The general recommendation is to delay, however if the patient is clinically well it may be appropriate to continue treatment; refer to treating team and/or local institutional guidelines
50 to less than 75 Delay treatment until recovery
less than 50 Delay treatment until recovery and reduce capecitabine by 25% for subsequent cycles
Kidney dosing recommendations 
  • Suggested dose modifications are based on the International Consensus Guideline on Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD).
  • Where one or more drugs in a protocol is recommended to be avoided, consider using a clinically appropriate alternative treatment protocol instead.
  • Before dose adjusting or omitting a drug, consider treatment intent.
  • In kidney replacement therapy consult a multidisciplinary team consisting of oncology/haematology with nephrology and/or clinical pharmacology for the management of dosing. 
  • For complete information on individual drug recommendations please review the individual drug monograph in the ADDIKD guideline.
eGFR
(mL/min/1.73m2)		 Capecitabine
≥ 60

Full dose
45 - 59

Consider 25% reduction*

OR

Alternative protocol

Increased risk of adverse events
30 - 44

Consider 25% reduction

OR

Alternative protocol 

Increased risk of adverse events
15 - 29

Avoid 

Not recommended - use alternative protocol
< 15
(without kidney replacement therapy)

Avoid 

Not recommended - use alternative protocol
* This differs from the ADDIKD Guideline and is RCM consensus 2023
Hepatic impairment
Hepatic dysfunction
Mild No dose modifications necessary
Moderate Reduce capecitabine by 25%
Severe Reduce capecitabine by 50%
Treatment related Grade 3 or Grade 4 hyperbilirubinaemia  Delay treatment until toxicity resolves to Grade 2 or less and reduce the dose of capecitabine for subsequent cycles as recommended above
Mucositis and stomatitis
Grade 2 Delay treatment until toxicity has resolved to Grade 1 or less and reduce the dose for subsequent cycles as follows:
1st occurrence: No dose reduction
2nd occurrence: Reduce capecitabine by 25%
3rd occurrence: Reduce capecitabine by 50%
4th occurrence: Omit capecitabine
Grade 3 or Grade 4 Delay treatment until toxicity has resolved to Grade 1 or less and reduce the dose for subsequent cycles as follows:
1st occurrence: Reduce capecitabine by 50%
2nd occurrence: Omit capecitabine
Diarrhoea
Grade 2 Delay treatment until toxicity has resolved to Grade 1 or less and reduce the dose for subsequent cycles as follows:
1st occurrence: No dose reduction
2nd occurrence: Reduce capecitabine 25%
3rd  occurrence: Reduce capecitabine by 50%
4th  occurrence: Omit capecitabine
Grade 3 or Grade 4 Delay treatment until toxicity has resolved to Grade 1 or less and reduce the dose for subsequent cycles as follows:
1st occurrence: Reduce capecitabine by 50%
2nd occurrence: Omit capecitabine
Hand foot syndrome (link to Hand foot syndrome (Palmar-plantar erythrodysaesthesia))
Grade 2 Delay treatment until toxicity has resolved to Grade 1 or less and reduce the dose for subsequent cycles as follows:
1st occurrence: No dose reduction
2nd occurrence: Reduce capecitabine 25%
3rd occurrence: Reduce capecitabine by 50%
4th occurrence: Omit capecitabine
Grade 3 Delay treatment until toxicity has resolved to Grade 1 or less and reduce the dose for subsequent cycles as follows:
1st occurrence: Reduce capecitabine by 50%
2nd occurrence: Omit capecitabine

The drug interactions shown below are not an exhaustive list. For a more comprehensive list and for detailed information on specific drug interactions and clinical management, please refer to the specific drug product information and the following key resources: 

For more information see References & Disclaimer.

Capecitabine
  Interaction Clinical management

Sorivudine* and analogues (e.g. brivudine*)

 Potentially fatal increased toxicity of fluorouracil, the active metabolite of capecitabine, due to reduced clearance Combination contraindicated and at least 4 weeks must elapse between the end of treatment with sorivudine (or analogues, such as brivudine) and the start of capecitabine therapy
Warfarin and other drugs metabolised by CYP2C9 (e.g. phenytoin etc.) Increased effects/toxicity of these drugs possible due to inhibition of CYP2C9 by capecitabine and/or its metabolites resulting in reduced clearance Avoid combination or monitor for increased effect/toxicity (e.g. INR can be increased by 91% in patients on warfarin)
Allopurinol Reduced efficacy of capecitabine possible due to reduced conversion to the active metabolites Avoid combination or monitor for reduced capecitabine efficacy
Cytidine deaminase (CDA) inhibitors (e.g. cedazuridine) Increased effect/toxicity of capecitabine possible due to reduced clearance Avoid combination or monitor for increased effect/toxicity

* currently not marketed in Australia

General
  Interaction Clinical management
Warfarin Anti-cancer drugs may alter the anticoagulant effect of warfarin. Monitor INR regularly and adjust warfarin dosage as appropriate; consider alternative anticoagulant.
Direct oral anticoagulants (DOACs) e.g. apixaban, rivaroxaban, dabigatran

Interaction with both CYP3A4 and P-gp inhibitors /inducers.

DOAC and anti-cancer drug levels may both be altered, possibly leading to loss of efficacy or toxicity (i.e. increased bleeding).

Apixaban: avoid concurrent use with strong CYP3A4 and P‑gp inhibitors. If treating VTE, avoid use with strong CYP3A4 and P‑gp inducers. 

Rivaroxaban: avoid concurrent use with strong CYP3A4 and P‑gp  inhibitors.

Dabigatran: avoid combination with strong P‑gp inducers and inhibitors.

If concurrent use is unavoidable, monitor closely for efficacy/toxicity of both drugs.
Digoxin Anti-cancer drugs can damage the lining of the intestine; affecting the absorption of digoxin. Monitor digoxin serum levels; adjust digoxin dosage as appropriate.
Antiepileptics Both altered antiepileptic and anti-cancer drug levels may occur, possibly leading to loss of efficacy or toxicity. Where concurrent use of an enzyme-inducing antiepileptic cannot be avoided, monitor antiepileptic serum levels for toxicity, as well as seizure frequency for efficacy; adjust dosage as appropriate.
Also monitor closely for efficacy of the anti-cancer therapy.
Antiplatelet agents and NSAIDs Increased risk of bleeding due to treatment related thrombocytopenia. Avoid or minimise combination.
If combination deemed essential, (e.g. low dose aspirin for ischaemic heart disease) monitor for signs of bleeding.
Serotonergic drugs, including selective serotonin reuptake inhibitors (SSRIs e.g. paroxetine) and serotonin noradrenaline reuptake inhibitors (SNRIs e.g. venlafaxine) Increased risk of serotonin syndrome with concurrent use of 5-HT3 receptor antagonists (e.g. palonosetron, ondansetron, granisetron, tropisetron, dolasetron, etc.) Avoid combination.
If combination is clinically warranted, monitor for signs and symptoms of serotonin syndrome (e.g. confusion, agitation, tachycardia, hyperreflexia).
For more information link to TGA Medicines Safety Update
Vaccines Diminished response to vaccines and increased risk of infection with live vaccines. Live vaccines (e.g. BCG, MMR, zoster and varicella) are contraindicated in patients on immunosuppressive therapy. Use with caution in patients on non-immunosuppressive therapy.
For more information; refer to the recommended schedule of vaccination for cancer patients, as outlined in the Australian Immunisation Handbook

eviQ provides safe and effective instructions on how to administer cancer treatments. However, eviQ does not provide every treatment delivery option, and is unable to provide a comprehensive list of cancer treatment agents and their required IV line giving set/filter. There may be alternative methods of treatment administration, and alternative supportive treatments that are also appropriate. Please refer to the individual product information monographs via the TGA and Australian Injectable Drugs Handbook websites for further information.

Days 1 to 14

This is an oral treatment

Any toxicity grade 2 or greater may require dose reduction, delay or omission of treatment and review by medical officer before recommencing treatment.

Anti-cancer drug patient assessment tool prior to each treatment.

Capecitabine

  • administer orally TWICE a day on days 1 to 14
  • to be swallowed whole with a glass of water; do not break, crush or chew
  • to be taken morning and night (approximately 12 hours apart) within thirty minutes after the end of a meal
  • tablets may also be dispersed in water if patient has swallowing difficulties:
    • place the required number of tablets in a disposable cup and fill with approximately 200mL of water, leave the tablets to dissolve (approximately 15 minutes) and swallow immediately
    • mix any residues in the cup with water and swallow
    • avoid direct contact of the tablets or solution with the skin or mucous membrane. If such contact occurs, wash thoroughly.

Note: missed doses should not be replaced; if a dose is forgotten or vomited, normal dosing should be resumed at the next scheduled dose.

Continue safe handling precautions until 7 days after completion of drug(s).

Discharge information

Capecitabine tablets - with written instructions on how to take them.

Antiemetics - as/if prescribed.

Antidiarrhoeals - as/if prescribed.

Patient information

Ensure patient receives protocol patient information sheet.

The side effects listed below are not a complete list of all possible side effects for this treatment. Side effects are categorised into the approximate onset of presentation and should only be used as a guide.

Immediate (onset hours to days)
Nausea and vomiting

Read more about prevention of treatment induced nausea and vomiting
Cardiotoxicity

Coronary artery spasm is a temporary, sudden narrowing of one of the coronary arteries that may present at any time during treatment with fluoropyrimidines. It most commonly manifests as angina.
Taste and smell alteration

Read more about taste and smell changes

Early (onset days to weeks)
Neutropenia

Abnormally low levels of neutrophils in the blood. This increases the risk of infection. Any fever or suspicion of infection should be investigated immediately and managed aggressively. 

Read more about immediate management of neutropenic fever
Thrombocytopenia

A reduction in the normal levels of functional platelets, increasing the risk of abnormal bleeding.  

Read more about thrombocytopenia
Diarrhoea

Read more about treatment induced diarrhoea
Oral mucositis

Erythematous and ulcerative lesions of the gastrointestinal tract (GIT). It commonly develops following anti-cancer treatment, radiation therapy to the head, neck or oesophagus, and high-dose chemotherapy followed by a blood and marrow transplant (BMT).

Read more about oral mucositis and stomatitis
Anorexia

Loss of appetite accompanied by decreased food intake.

Read more about anorexia
Fatigue

Read more about fatigue
Actinic keratoses flare

Pre-existing actinic keratoses (AKs) can become more inflamed and scaly as a result of immunosuppression. 

Read more about actinic keratoses flare
Palmar-plantar erythrodysaesthesia (PPE) - hand-foot syndrome (HFS)

Bilateral erythema, tenderness, pain, swelling, tingling, numbness, pruritus, dry rash, or moist desquamation and ulceration of the palms and soles. It is also known as hand-foot syndrome (HFS). Symptoms appear to be dose dependent and palms are affected more than soles.

Read more about hand-foot syndrome associated with chemotherapy
Skin rash

Anti-cancer drugs can cause a number of changes in the skin with maculo-papular rash the most common type of drug-induced skin reaction. 

Read more about skin rash
Ocular changes

Symptoms may include eye pain, blurred vision, blepharitis, uveitis, optic neuritis, tear duct stenosis, conjunctivitis, hyperlacrimation, watery or dry eyes and photophobia. 
Photosensitivity

Increased sensitivity to ultraviolet (UV) light resulting in an exaggerated sunburn-like reaction accompanied by stinging sensations and urticaria.
Abdominal pain

Dull ache, cramping or sharp pains are common with some anti-cancer drugs. These are caused by either increased or decreased gastrointestinal motility and can be associated with diarrhoea or constipation.

Late (onset weeks to months)
Anaemia

Abnormally low levels of red blood cells (RBCs) or haemoglobin in the blood. 

Read more about anaemia
Hyperbilirubinaemia

An abnormal increase in the amount of bilirubin circulating in the blood which may result in jaundice.

The evidence supporting the use of capecitabine in the first-line setting for the treatment of metastatic colorectal cancer comes from the results of 2 large open-label randomised controlled phase III trials.r

Between September 1996 and February 1998, a total of 1207 patients were randomised; 603 patients to oral capecitabine (1250 mg/m2 twice daily for 14 days followed by a 7 day rest period) and 604 patients to the Mayo Clinic 5-FU/FA regimen (5-FU 425 mg/m2 and FA 20 mg/m2 days 1 to 5 every 28 days).

The primary end point of the trial was the overall tumour response rate (complete response and partial response), to establish that oral capecitabine achieves a response rate at least equivalent to the Mayo Clinic regimen in patients with previously untreated metastatic colorectal cancer.

Secondary end points included time to disease progression, overall survival, duration of response and time to first response, as well as safety and quality of life profiles and medical resource utilisation during treatment.

Efficacy

The results from the integrated analysis demonstrated a significantly superior overall response rate with capecitabine compared with the Mayo Clinic regimen (26 vs 17%; p<0.0002). However, there were no statistically significant differences for the number of patients achieving stable disease, time to progression or overall survival between treatment groups.r

Van Cutsemr Capecitabine (n=603) 5-FU/FA (n=604) p-value
Overall response rate 25.7%  16.7% <0.0002 
Stable disease 48.3%  52.2%   NS
Median time to progression 4.6 months  4.7 months   NS
Median overall survival 12.9 months 12.8 months  NS

NS: non significant

Toxicity

Capecitabine demonstrated a safety profile superior to that of 5-FU/FA (Mayo regimen), with a significantly lower incidence of diarrhoea, stomatitis, nausea, alopecia and grade 3 or 4 neutropenia leading to significantly fewer neutropenic fever/sepsis cases and fewer hospitalizations. The most frequently occurring toxicities in the capecitabine group were hand-foot syndrome and diarrhoea.r

Toxicityr

© Annals of Oncology 2002

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Version 6

Date Summary of changes
31/01/2024 Protocol assessed by eviQ medical oncology reference committee and deemed suitable to be reviewed as required. Flag added, review date removed and version number increased to V.6. Read more about as required review protocol status in this factsheet.

Version 5

Date Summary of changes
14/09/2023

Protocol updated with ADDIKD guideline recommendations. New kidney dosing recommendation table added to dose modification section.

PDF of previous protocol.

Version number changed to V.5.

Version 4

Date Summary of changes
11/04/2007 Independent evaluation added.
02/12/2007 Patient Information Sheet oral chemotherapy safety added.
21/08/2009 Review, new dose modifications added and transferred to eviQ.
01/07/2010 Haematological dose modifications updated ( 20% changed to 25% dose reduction).
25/01/2011 New format to allow for export of protocol information.
Protocol version number changed to V.2.
Antiemetics and premedications added to the treatment schedule.
Additional Clinical Information, Key Prescribing table and Key Administration table combined into new section titled Clinical Considerations.
Drug specific information placed behind the drug name link.
22/03/2012 PHC OMIS view updated.
13/09/2013 Protocol reviewed at Medical Oncology Reference Committee meeting.
Group consensus to change fixed dosing of capecitabine to mg/m2 dosing to reflect published evidence.
Next review in 2 years.
24/08/2014 PHC view removed.
18/02/2016 Discussion with Medical Oncology Reference Committee Chairs and protocol to be reviewed every 5 years. Next review due in 3 years.
09/11/2016 The following changes made post Medical Oncology Reference Committee meeting held on 21 October 2016: link to AGTIG and ANZCTR added.
16/12/2016 Dissolving capecitabine information added to administration and patient information.
31/05/2017 Transferred to new eviQ website. Version number change to V.4.
15/06/2017

Link to the independent evaluation of the evidence completed in 2006/7 removed from the evidence section as no longer relevant.

Hepatitis screening changed to not recommended.
16/02/2018 Protocol reviewed electronically by Medical Oncology Reference Committee. Note re starting at a lower capecitabine dose added for consistency with ID 1175, fluoropyrimidine warning added. Review in 5 years.
10/05/2018 Haematological dose modifications updated as per consensus of the expert clinician group. Version number changed to V.4.
21/12/2021 Changed antiemetic clinical information block to minimal or low, to align with new categories. See ID 7 Prevention of anti-cancer therapy induced nausea and vomiting (AINV) v5.
20/10/2022

Protocol reviewed electronically by Medical Oncology Reference Committee. No changes. Next review 4 years.

The information contained in this protocol is based on the highest level of available evidence and consensus of the eviQ reference committee regarding their views of currently accepted approaches to treatment. Any clinician (medical oncologist, haematologist, radiation oncologist, medical physicist, radiation therapist, pharmacist or nurse) seeking to apply or consult this protocol is expected to use independent clinical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. While eviQ endeavours to link to reliable sources that provide accurate information, eviQ and the Cancer Institute NSW do not endorse or accept responsibility for the accuracy, currency, reliability or correctness of the content of linked external information sources. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au

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10 Sep 2024