Xeloda (capecitabine) is an oral chemotherapy drug used to treat several types of cancer, including colorectal, breast, gastric, esophageal, and pancreatic cancers. Unlike many chemotherapy drugs that require IV infusion at a clinic, Xeloda is a tablet you take at home, making it one of the more common oral chemotherapy options prescribed today.
Cancers Treated With Xeloda
Xeloda is FDA-approved for a broad range of cancer types and stages. For colorectal cancer, it serves two roles: as a standalone treatment after surgery for colon cancer (called adjuvant therapy) and as ongoing treatment for colorectal cancer that has spread or can’t be surgically removed. In the adjuvant setting, treatment typically runs for a maximum of eight cycles. For metastatic disease, it continues until the cancer progresses or side effects become unmanageable.
For breast cancer, Xeloda is approved for advanced or metastatic cases. It’s often used after other chemotherapy regimens have been tried.
Xeloda is also approved for cancers of the stomach, esophagus, and the junction between them. In these cases, it’s typically combined with other chemotherapy agents rather than used alone. For a specific subtype of stomach cancer that overexpresses a protein called HER2, Xeloda is part of a three-drug combination regimen.
More recently, Xeloda gained approval for adjuvant treatment of pancreatic cancer after surgery, used in combination with another chemotherapy drug. This expanded the medication’s role beyond the cancers it was originally approved for.
How Xeloda Works
Xeloda is a prodrug, meaning it’s inactive when you swallow it. Your body converts it into the active cancer-fighting compound through a three-step process involving different enzymes. The final conversion step happens preferentially inside tumor cells, where an enzyme called thymidine phosphorylase is often present at higher levels than in normal tissue. This design helps concentrate the drug’s activity where it’s needed most, reducing some of the collateral damage to healthy cells that traditional IV chemotherapy can cause.
How You Take It
Xeloda follows a cyclical schedule. The most common pattern is 14 days on treatment followed by 7 days off, forming a 21-day cycle. You take tablets twice daily, once in the morning and once in the evening, within 30 minutes of finishing a meal. The tablets should be swallowed whole with water, not crushed or cut.
Your specific dose depends on your body size and which cancer is being treated. The number of cycles varies too. Adjuvant colon cancer treatment runs up to eight cycles (about six months), while treatment for metastatic cancers continues for as long as it’s working and tolerable. For stage III colorectal cancer, research from the IDEA collaboration has shown that three months of Xeloda combined with oxaliplatin produces very similar survival outcomes to the conventional six months, with significantly lower rates of nerve damage (16% versus 47% for moderate-to-severe cases). This shorter option is now standard for many patients.
Common Side Effects
The most distinctive side effect of Xeloda is hand-foot syndrome, a condition where the palms of your hands and soles of your feet become red, swollen, tender, and sometimes blistered. About 10% of patients on Xeloda alone develop a severe form of this reaction. The rate climbs significantly when Xeloda is paired with other chemotherapy drugs, reaching 24% or higher depending on the combination. Milder versions of hand-foot syndrome are even more common and can often be managed with moisturizers, dose adjustments, and avoiding activities that create friction or heat on the hands and feet.
Other frequent side effects include diarrhea, nausea, fatigue, and mouth sores. These are typical of chemotherapy drugs in this class and tend to improve during the week-off portion of each cycle.
DPD Deficiency: A Critical Safety Issue
Before starting Xeloda, you should be tested for a genetic condition called DPD deficiency. The enzyme DPD is responsible for breaking down more than 80% of the drug’s active form in your body. People who lack this enzyme, or produce very little of it, can’t clear the drug properly. This leads to a dangerous buildup that can cause severe, potentially fatal reactions including intense diarrhea, dangerously low white blood cell counts, and neurological damage.
The FDA now requires a boxed warning (the strongest safety alert) about this risk and recommends genetic testing before treatment begins. People with complete DPD deficiency should not take Xeloda. Those with partial deficiency may still be treated, but at a reduced dose tailored to their individual situation.
Blood Thinner Interactions
Xeloda has a well-documented and serious interaction with warfarin and similar blood-thinning medications. It interferes with the liver enzyme that processes warfarin, which can cause blood-thinning levels to spike dramatically. In clinical studies, the key measure of blood-thinning activity increased by 91% when warfarin was given alongside Xeloda. Post-marketing reports have documented cases of dangerous bleeding and death from this interaction.
The interaction can appear within days of starting Xeloda or develop gradually over months. It can even occur shortly after stopping Xeloda. If you take a blood thinner, your clotting levels will need to be checked frequently throughout treatment, and your blood thinner dose will likely need to be reduced.