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Capecitabine: have we got the dose right?
1Department of Clinical Pharmacology, University of Oxford, Woodstock Road, Oxford, UK. rachel.midgley@clinpharm.ox.ac.uk
Nature Clinical Practice. Oncology
|October 22, 2008
Summary
The oral chemotherapy drug capecitabine is increasingly replacing 5-fluorouracil due to similar efficacy and toxicity. However, a universal starting dose is not ideal due to patient variability and geographical differences in capecitabine toxicity.
Area of Science:
- Oncology
- Pharmacology
- Clinical Pharmacy
Background:
- Capecitabine, an oral prodrug of 5-fluorouracil, is increasingly used in chemotherapy regimens.
- Its use is supported by evidence of comparable efficacy and toxicity to intravenous 5-fluorouracil.
- Current dosing practices for capecitabine vary globally, often based on regional toxic event experiences.
Purpose of the Study:
- To investigate the reasons behind the lack of a universally applicable starting dose for capecitabine.
- To explore the influence of interpatient variability (physiology, pharmacogenomics, diet) on capecitabine dosing.
- To examine the factors contributing to geographical variations in capecitabine toxicity.
Main Methods:
- Review of existing literature on capecitabine pharmacokinetics and pharmacodynamics.
- Analysis of factors influencing drug metabolism and patient response.
- Exploration of geographical differences in reported capecitabine-related toxicities.
Main Results:
- Interpatient differences in physiology, pharmacogenomics, and diet significantly impact capecitabine efficacy and toxicity.
- Geographical variations in capecitabine toxicity are linked to these interpatient factors.
- Individual patient characteristics necessitate dose modification even within the same geographical region.
Conclusions:
- A standardized starting dose for capecitabine may not be optimal due to significant interpatient variability.
- Clinicians should consider individual patient factors and regional data to personalize capecitabine dosing.
- Further research into pharmacogenomic and dietary influences can refine capecitabine treatment protocols.
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