Page 1 CAPECITABINE + OXALIPLATIN CANCER TREATMENT EDUCATION Name of the regimen and anti-cancer drugs o Oral Treatment Generic name (pronunciation): capecitabine (ka-peh-SY-tuh-been) Brand name: Xeloda® (zeh-LOH-duh) o Infusion Treatment Generic name (pronunciation): oxaliplatin (ok SA lih pla tin) Brand name: Eloxatin® Your care team may refer to your treatment as “CapeOx” or “XELOX”. Capecitabine and Oxaliplatin consists of 2 different anticancer therapies. o Cape = capecitabine o Ox = Oxaliplatin o Xel = Xeloda Common uses This regimen is mostly commonly used for colorectal, biliary, gastric and biliary cancers but may be used for other cancers. Treatment dose and schedule The first part of your treatment will be given into your vein through an intravenous (IV) line. This may be into a short, flexible temporary catheter in your arm, or through a central venous catheter. A central venous catheter, or central line, is a long, flexible IV tube that empties into a very large vein next to the heart. Talk with your care team to see which will be best for you and your treatment. The second part of your treatment will be given orally. This medication will be ordered by your provider to take by mouth at home. Each oxaliplatin and capecitabine treatment is repeated every 21 days. This is known as one cycle. Your treatment may be given for a set number of cycles, or it will keep going until the drug, or drugs, stop working or you have side effects which stop you from continuing treatment. o Your oxaliplatin is given on day 1 of each treatment cycle. o Your capecitabine should be taken twice daily on days 1-14 of each treatment cycle. Taking capecitabine as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. o Your dose is based on many factors, including your height and weight, overall health and diagnosis. o Capecitabine should be taken with water, within 30 minutes after a meal, at the same times each day. o Capecitabine should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow capecitabine, talk to your care provider or pharmacist for possible options. o If you miss a dose of capecitabine, do not take two doses at one time. Simply take the next dose at the regularly scheduled time. Be sure to write down if you miss a dose and let your care provider know about any missed doses. Page 2 CAPECITABINE + OXALIPLATIN CANCER TREATMENT EDUCATION Capecitabine dose, schedule, and administration Obtaining medication Talk with your care provider about the process for obtaining your capecitabine. Other medications Other medications may be ordered for you to prevent or treat certain side effects. These include: Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Days 15–21 Cycle 2 Day 1 IV Medication Given at Infusion Center Oxaliplatin X X Oral Medication Taken at Home Capecitabine AM Week off X PM X Instructions Anti-nausea medications You may receive medications to prevent nausea from your cancer treatment. Additional supportive medications You may receive medications to prevent side effects during your cancer treatment. Page 3 CAPECITABINE + OXALIPLATIN CANCER TREATMENT EDUCATION Possible drug interactions o Capecitabine and oxaliplatin may interact with other drugs you are taking. Please inform your care providers of all prescription medicine, over-the-counter medications, vitamins, and herbal products that you take. o Talk with your care provider or pharmacist before taking new medications, supplements, or receiving any vaccines. Common Side Effects of Capecitabine and Oxaliplatin Common side effects that have been known to happen in patients receiving CAPECITABINE AND OXALIPLATIN are listed in the left side of this table. In some instances, the side effects may be reported less often but are still important to discuss. This table does not list all the known side effects for this therapy, only the ones that are experienced most often. Not every patient experiences every known side effect of a drug; even if you are taking the same drug as another patient, you may experience different side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Decreased white blood cells (WBCs) and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection: • Wash your hands often, especially before eating and after using the bathroom. • Avoid crowds and people with fevers, flu, or other infection. • Bathe often for good personal hygiene. Contact your care team if you experience any signs or symptoms of an infection such as: • Fever (temperature more than 100.4°F or 38°C) • Chills • Sore throat • Burning when peeing • Tiredness that is worse than normal • A sore that becomes red, is draining, or does not heal Check with your care team before taking any medicine for a fever or chills. Continued on the next page Page 4 CAPECITABINE + OXALIPLATIN CANCER TREATMENT EDUCATION Possible Side Effect Management Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. • Use caution to avoid bruises, cuts, or burns. • Blow your nose gently and do not pick your nose. • Brush your teeth gently with a soft toothbrush and maintain good oral hygiene. • When shaving use an electric razor instead of razor blades. • Use a nail file instead of a nail clippers. Call your care team if you have bleeding that won’t stop. Examples include: • A bloody nose that bleeds for more than 5 minutes despite pressure • A cut that continues to ooze despite pressure • Gums that bleed a lot when you floss or brush Seek medical help right away if you have any severe headaches, blood in your urine or stool, coughing up blood, or bleeding that you cannot stop or lasts a long time. You may need to take a break or “hold” your medication for medical or dental procedures. Talk to your care team or dentist before any scheduled procedures. Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be checked by a simple blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. • Try to get 7 to 8 hours of sleep per night. • Avoid operating heavy machinery if you feel too tired. • Find a balance between “work” and “rest.” • Stay as active as possible, but know that it is okay to rest as needed, too. • You might notice that you are more pale than usual. Let your care team know right away if you have: • Shortness of breath • Dizziness • Fast or abnormal heartbeat Continued on the next page Page 5 CAPECITABINE + OXALIPLATIN CANCER TREATMENT EDUCATION Possible Side Effect Management Diarrhea (loose and/ or urgent bowel movements) Monitor how many bowel movements you have each day. • Drink 8-10 (8-ounce) glasses of water or fluid each day unless your care team has asked you to limit your fluid intake. • Eat small, frequent meals throughout the day rather than a few large meals. • Eat bland, low-fiber foods (such as bananas, applesauce, potatoes, chicken, rice, and toast). • Avoid high fiber foods, such as raw vegetables and fruits and whole grains. • Avoid foods that cause gas, such as broccoli and beans. • Avoid foods with lactose, such as yogurt and milk. • Avoid spicy, fried, and greasy foods. Contact your care team if: • The number of bowel movements you have in a day increases by 4 or more. • You feel dizzy or lightheaded. Your care team may recommend an over-the-counter medication or prescribe something to help manage your symptoms. Nausea or vomiting • Take all medications as prescribed to help prevent and lessen symptoms of nausea and vomiting. • Eat and drink slowly. • Drink 8-10 (8-ounce) glasses of water and/or fluid (soup or broth) each day unless your care team has instructed you to limit your fluid intake. • Eat small, frequent meals throughout the day rather than a few large meals. • Eat bland foods; avoid spicy, fried, and greasy foods. • Avoid intense exercise immediately after eating. • Don’t lay down right away after eating. • Wear loose fitting clothing for comfort. • Avoid strong odors. Consider getting fresh air and try deep breathing. Let your care team know if you have nausea or vomiting. Your care team may prescribe medication to help with the symptoms. Continued on the next page Page 6 CAPECITABINE + OXALIPLATIN CANCER TREATMENT EDUCATION Possible Side Effect Management Fatigue • You may be more tired than usual or have less energy. • Stay as active as possible, but know it is okay to rest as needed. • Try to do some type of moderate activity every day. • Conserve your energy. Plan your activities and do them at a time of day when you feel a bit more energetic. • Follow a healthy diet and stay hydrated. • Accept help from family and friends. • Find healthy ways to manage stress, such as meditation, journaling, yoga, and guided imagery. • Develop good sleeping habits, limit napping during the day to help you sleep better at night. • Avoid operating heavy machinery if you feel too tired. Contact your care team if you experience extreme fatigue that prevents you from doing your normal daily activities. Sensitivity to cold Oxaliplatin can cause you to be VERY sensitive to cold for 3-7 days after treatment. • Avoid exposure to cold temperatures or touching cold objects. • Avoid cold drinks, ice and cold food. Use a straw when drinking cool liquids. • Wear gloves when reaching into the freezer or handlng cold objects. • Wear gloves and cover mouth with a scarf during cold weather. Mouth irritation or sores (stomatitis or mucositis) Practice good mouth care. • Rinse your mouth after meals and at bedtime, and more frequently if you develop sores in your mouth. • Brush your teeth with a soft toothbrush or cotton swab after meals. • Use a mild non-alcohol mouth rinse at least 4 times a day (after eating and at bedtime). One example is a mixture of 1/8 teaspoon of salt and 1/4 teaspoon of baking soda in 8 ounces of warm (not hot) water. • Avoid acidic, hot or spicy foods and beverages, and rough foods that might irritate the mouth. • If you have sores in your mouth, avoid using tobacco products, alcohol, and mouthwashes that contain alcohol. Call your care team if you experience pain or sores in your mouth or throat. Numbness or tingling in hands and feet Report changes in your sense of touch, such as a burning feeling, pain on the skin or weakness. Continued on the next page Page 7 CAPECITABINE + OXALIPLATIN CANCER TREATMENT EDUCATION Possible Side Effect Management Pain or discomfort in hands and/or feet Capecitabine can cause hand-and-foot syndrome (HFS), a skin reaction that appears on the palms of the hands and soles of the feet. It can appear as a rash, peeling skin, or feel like “pins and needles.” Let your care team know right away if you experience this side effect. To prevent HFS, you can: • Keep hands and feet moisturized with a non-fragranced moisturizing cream. • Urea 10% or 20% cream may be helpful. • Avoid exposure to hot water on the hands and feet, in showers, baths or doing dishes. • Avoid tight shoes or socks. • Avoid excess rubbing on hands and feet unless putting on lotion. • Wear gloves when working with your hands. Sun sensitivity – sunburn easily • Avoid sun exposure as much as possible to decrease the risk of sunburn. The highest exposure to UV (ultraviolet) radiation occurs between the hours of 10 am and 4 pm. • Wear long-sleeved clothing, with UV protection if possible. • Wear broad-brimmed hats. • Apply broad-spectrum sunscreen (UVA/UVB) with at least SPF 30 as often as directed on the bottle. • Use lip balm with at least SPF 30. Rare but serious side effects o If you experience ANY new, worsening, or uncontrolled side effects, call your care team immediately. o Interstitial lung disease: Oxaliplatin may cause harm to your lungs. Inform your care team of any new or worse difficulty breathing, cough, shortness of breath, chest pain, or fever. Your provider may stop treatment if your lungs are affected. o Hypersensitivity reactions: Severe allergic reactions are a rare but serious side effect of oxaliplatin. Seek medical attention right away if you notice difficulty breathing, swelling of the mouth or tongue, or a serious rash. o You may have increased risk of bleeding if you take warfarin (Coumadin®) with capecitabine and for up to 1 month after stopping capecitabine therapy. o Capecitabine can cause cardiotoxicity, which is a condition when there is damage to your heart muscle. Seek medical attention right away if you have any chest pain or tightness. o Oxaliplatin and capecitabine may be harmful to your kidneys. Speak to your care team to know when you need to have laboratory tests done to monitor your kidneys. Contact your care team if you notice swelling in your legs and feet or a decreased amount of urination. o Dehydration happens when you use or lose more water than you take in and your body doesn’t have enough water or other fluids to carry out its normal functions. capecitabine. Talk with your care team about how much fluid you should drink. o Dihydropyrimidine dehydrogenase (DPD) deficiency is a rare genetic condition where the body cannot break down certain cancer treatments, leading to severe side effects. Talk to your doctor to see if you should be tested. Page 8 CAPECITABINE + OXALIPLATIN CANCER TREATMENT EDUCATION o Oxaliplatin is an irritant. If it leaks outside of the IV, it can cause severe damage to your skin. Notify your nurse right away if you feel any pain, aching, burning, itching, swelling, or redness at the site of your IV. Storage and handling of capecitabine Handle capecitabine with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of others to the drug should be limited. o Store capecitabine at room temperature (68 to 77 F) in a dry location away from light. o Keep capecitabine out of reach of children and pets. o Whenever possible, you should give capecitabine to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the capecitabine to you, they also need to follow these steps. • Wash hands with soap and water. • Put on gloves to avoid touching the medication. (Gloves are not necessary if you give the drug to yourself.) • Gently transfer the capecitabine from its package to a small medicine or other disposable cup. • Administer the medicine immediately by mouth with water. • Remove gloves and do not use them for anything else. • Throw gloves and medicine cup in household trash. • Wash hands with soap and water. o If a daily pill box or pill reminder will be used, contact your care team before using: • Use a separate pill box for your capecitabine. Do not mix in a box with other medications. • The person filling the box or reminder should wear gloves (gloves are not necessary if you are filling the box or reminder yourself). • When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. o If you have any unused capecitabine, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of capecitabine. o If you are traveling, put your capecitabine’s packaging in a separate sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Some of the drugs you receive may be present in urine, stool, sweat, or vomit for many days after treatment. Many cancer drugs are toxic, your bodily waste may also be toxic and can be dangerous to come into contact with. Once you have started CAPECITABINE AND OXALIPLATIN follow the instructions below during your treatment. This is to keep you, your loved ones, and the environment as safe as possible. Page 9 CAPECITABINE + OXALIPLATIN CANCER TREATMENT EDUCATION o Pregnant women should avoid touching anything that may be soiled with your body fluids. o Toilet and septic systems: • You may use the same toilet, septic tank, and/or sewer that you usually use. Close the lid and flush to ensure all waste has been discarded. If you have a low-flow toilet, close the lid and flush twice. o If the toilet or toilet seat is soiled with urine, stool, or vomit, clean the surface after every use before other people use the toilet. o Wash hands with soap and water for at least 20 seconds after using the toilet. o If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. o If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. o Wash any skin that has been exposed to body waste with soap and water. o Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. o Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Pregnancy, sexual activity, and contraception o Patients of reproductive ability should not become pregnant or get their partners pregnant while recieving CAPECITABINE AND OXALIPLATIN. Patients of childbearing age and potential should use effective contraception during therapy and for a minimum of 6 months after the last dose of capecitabine. o Talk to your care team about birth control. Not all options may be right for your treatment or cancer. Effective contraception could include one or more of the following: barrier methods (e.g., condoms), hormone methods (e.g., birth control pills), or surgery. o Do not breastfeed while taking CAPECITABINE AND OXALIPLATIN and for 2 weeks after the last dose of capecitabine. o Please inform your care provider if you become pregnant. o Some treatments can influence the ability to have children, also known as fertility. If you’re interested in preserving fertility, talk to your care team before treatment. Ask your healthcare provider to determine when it is safe to become pregnant after your treatment. o It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy and you are encouraged to ask your care team for assistance. o Some of the drugs you receive may be present in semen and vaginal secretion for many days after treatment. You should use barrier devices, such as condoms, during sexual activity to limit exposure to body fluids. Page 10 CAPECITABINE + OXALIPLATIN CANCER TREATMENT EDUCATION Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy-to-understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2022 by Hematology/Oncology Pharmacy Association. All rights reserved. Additional resources Prescribing information links: Capecitabine: https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/020896s037lbl.pdf Oxaliplatin: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/021492s016lbl.pdf Updated – September 28, 2022 Additional instructions