1. What is capecitabine?
Capecitabine is a drug.
Capecitabine is the non-branded name of the drug, but you may also hear it called by its brand name Xeloda.
2. When is capecitabine given?
When breast cancer has spread
Capecitabine is used to treat breast cancer that has come back after previous treatment and has:
- Spread to the tissues and around the chest, neck or under the breastbone (locally advanced breast cancer)
- Spread to other parts of the body (secondary breast cancer)
For some people with primary breast cancer
Studies have shown that some people with may benefit from capecitabine.
This includes people with breast cancer that is triple negative.
People who have chemotherapy before surgery may be offered capecitabine after their surgery.
Your treatment team will discuss with you, if this is an option.
As part of a clinical trial
Capecitabine may be offered as part of a clinical trial.
3. Before starting capecitabine
Before starting your treatment many hospitals will arrange a chemotherapy information session.
A nurse will explain how and when you’ll have your chemotherapy and how side effects can be managed.
You should have blood tests and some people will have an ECG (electrocardiogram), a simple test that checks your heart rhythm.
It’s recommended everyone starting capecitabine has a blood test to check levels of a protein called DPD.
Your height and weight will also be measured, to work out the correct dose of chemotherapy for you.
You’ll be given contact numbers so you know who to phone if you have any questions or concerns.
4. How is capecitabine taken?
Different ways chemotherapy can be given
Capecitabine is taken as a tablet (orally).
You should swallow the tablets whole with water within half an hour of eating a meal.
You usually take the capecitabine tablets twice a day (in the morning and evening) for 14 days and then have a 7-day break from taking the tablets. This 21-day period is one treatment cycle.
If you’re prescribed capecitabine differently to the 21-day cycle, your doctors will explain why.
Capecitabine is available in two different tablet strengths: 150mg or 500mg. You’ll be told how many of each tablet to take, to make sure you get the right amount each day for your body size.
It’s often given on its own, but can be given alongside other chemotherapy drugs like docetaxel.
What happens if I miss a dose?
If you miss a dose of capecitabine, do not take an extra dose to make up for the one you missed.
Take the next dose at the usual time and speak to someone in your treatment team.
How long will I have to take capecitabine for?
This will vary from person to person.
People with secondary breast cancer will usually keep taking capecitabine until it’s no longer helping control the cancer or they have significant side effects.
If you have primary breast cancer, your treatment team will talk to you about what’s best for you.
5. Side effects of capecitabine
Most people tolerate capecitabine well as the side effects are often mild and can usually be controlled. But everyone reacts differently to drugs.
Some people have more side effects than others, and the side effects described here will not affect everyone.
If you’re taking other drugs at the same time as capecitabine, you may have side effects from these drugs too.
If you’re concerned about any side effects, regardless of whether they’re listed here, talk to your chemotherapy nurse or cancer specialist (oncologist) as soon as possible.
Your specialist can reduce or delay the dose of capecitabine you take if the side effects become too severe.
Reducing the dose of capecitabine is common and the treatment can still be effective at a lower dose.
Common side effects
Effects on the blood
Capecitabine can temporarily affect the number of blood cells in the body.
You’ll have regular blood tests to check your blood count. Blood is made up of red cells, white cells and platelets. If the number of blood cells is too low, your next cycle of treatment may be delayed or the dose of chemotherapy reduced.
Risk of infection
Not having enough white blood cells can increase the risk of getting an infection.
Signs of an infection
Your treatment team may give you guidelines to follow for reporting signs of an infection. But generally you should contact your hospital immediately if you experience any of the following:
- A high temperature (over 37.5°C) or low temperature (under 36°C), or whatever your treatment team has advised
- Suddenly feeling unwell, even with a normal temperature
- Symptoms of an infection, for example a sore throat, a cough, a need to pass urine frequently or feeling cold or shivery
Chemotherapy side effects
Before starting chemotherapy you should be given a 24-hour contact number, or told where to get emergency care by your treatment team. You may need antibiotics.
Sometimes your doctor may recommend injections of drugs called growth factors. This helps the body produce more white blood cells to reduce your risk of infection.
Having too few red blood cells is called anaemia. If you feel particularly tired, breathless or dizzy, let your treatment team know.
Bruising and bleeding
Capecitabine can reduce the number of platelets, which help the blood to clot. You may bruise more easily, have nosebleeds or your gums may bleed when you brush your teeth. Tell your treatment team if you experience any of these symptoms.
Diarrhoea is common during treatment and can sometimes be severe.
Tell your chemotherapy nurse or treatment team as they can prescribe medication and may consider stopping your capecitabine for a time to help control it.
Speak to them immediately if you have any of the following symptoms:
- Four or more episodes of diarrhoea in 24 hours
- Blood in your stools when you go to the toilet
- Tummy (abdominal) pain
Hand-foot syndrome, often called Palmar-Plantar syndrome, is a common side effect of some chemotherapy drugs used to treat breast cancer.
The palms of the hands and the soles of the feet can become red and sore. Sometimes you may also notice a tingling sensation, numbness or some swelling.
The skin on your hands and feet may also become red, dry and flaky. This should improve if the treatment is delayed or if the dose is reduced.
Your treatment team can recommend moisturising creams to help with skin reactions.
Nausea and vomiting
You may feel sick (nausea) during treatment.
Although most people will not be sick (vomit), anti-sickness drugs can help reduce or stop this happening, so take these as prescribed. Steroids may also be given to make the anti-sickness drugs work more effectively.
Contact your treatment team or GP if symptoms don’t go away.
Your mouth and gums can become sore and small ulcers may develop. This is usually worse if you’re taking capecitabine at the same time as other chemotherapy drugs.
Your chemotherapy nurse or treatment team will advise you about suitable mouthwashes or medicine if these problems occur.
Looking after your mouth, including your teeth and gums, is very important during treatment.
It’s advisable to see your dentist for a dental check-up before chemotherapy begins and to avoid dental treatment during chemotherapy if possible.
If you do need to have dental treatment during chemotherapy, talk with your oncologist about the best time to have this.
Loss of appetite
You can lose your appetite while taking capecitabine. Your sense of taste can also change and some foods and drink may taste different.
Talk to your treatment team about this. They will give you advice and information to help, or refer you to a dietitian if needed.
Find out more about diet during treatment.
Cancer-related fatigue is extreme tiredness that doesn’t go away with rest or sleep. It’s a very common side effect of breast cancer treatment and may affect you physically and emotionally.
If you think you have fatigue, tell your GP or treatment team. They can assess you and offer advice on how to manage your energy levels.
Find out more about managing fatigue.
When used on its own, capecitabine occasionally causes some temporary hair thinning. It very rarely causes complete hair loss.
If capecitabine is taken in combination with another chemotherapy drug, most people will lose all their hair including eyebrows, eyelashes and body hair.
Find out more about hair loss.
Rare side effects
Very occasionally allergic reactions to a drug can occur. Reactions can vary from mild to severe, although severe reactions are uncommon.
If you have any swelling, wheezing, chest pain or difficulty breathing after taking capecitabine, let your treatment team or chemotherapy nurse know immediately.
DPD deficiency (very rare)
DPD is a type of protein (enzyme) made naturally in the body.
Not having enough DPD can cause chemotherapy to build up in the body, resulting in severe side effects. In very rare cases this can be life-threatening.
It’s recommended that everyone starting capecitabine has a blood test to check levels of DPD.
If you’re found to have low levels of DPD, known as a DPD deficiency, you may not be given the drug.
At your pre-assessment appointment, a member of the oncology team will explain the blood test.
Cancer Research UK has more information on DPD deficiency.
6. Other important information
People with breast cancer have a higher risk of blood clots. Their risk is higher because of the cancer itself and some treatments for breast cancer.
If the cancer has spread to other parts of the body (secondary breast cancer), this also increases the risk.
Having capecitabine increases the risk of blood clots like deep vein thrombosis (DVT).
People with a DVT are at risk of developing a pulmonary embolism (PE). This is when part of the blood clot breaks away and travels to the lung.
Blood clots can be harmful but are treatable, so it’s important to report symptoms as soon as possible.
Blood clot symptoms
If you have any of the following symptoms, contact your treatment team or go to your local A&E department immediately:
- Pain, redness/discolouration, heat and swelling of the arm or leg
- Swelling, redness or tenderness where a central line is inserted to give chemotherapy - for example in the arm, chest area or up into the neck
- Shortness of breath
- Pain or tightness in the chest
- Unexplained cough or coughing up blood
Find out more about blood clots.
Driving and using machinery
Capecitabine may make you feel dizzy, sick or tired. This could affect your ability to drive or operate machinery safely.
Avoid driving or using machinery if you have any symptoms that may affect your ability to do this.
Can I take capecitabine with other drugs?
Tell your treatment team about any other drugs or supplements you’re taking.
If you take drugs to thin the blood (anti-coagulants), like warfarin, capecitabine can increase your risk of bleeding.
Your specialist may check more often how quickly your blood clots, adjust your dose of blood-thinning drugs or, more commonly, change you to an injection to thin the blood instead.
Sex, contraception and pregnancy
You’re advised not to become pregnant while having treatment because capecitabine can harm a developing baby.
If you haven’t been through the menopause, talk to your team about the most suitable method of contraception for you. It’s still possible to become pregnant even if your periods become irregular or stop.
You can still have sex during treatment. It’s thought that chemotherapy drugs can’t pass into vaginal fluids or semen. But this can’t be completely ruled out as chemotherapy drugs can pass into the blood and some other body fluids.
Most hospital specialists will advise using barrier methods of contraception, such as condoms during treatment, and for a few days after chemotherapy is given.
Travel and vaccinations
If you’re planning a holiday or need to travel overseas, check with your treatment team first.
You should not have any live vaccines while you are having chemotherapy. Live vaccines include mumps, measles, rubella (German measles), polio, BCG (tuberculosis), shingles and yellow fever.
Live vaccines contain a small amount of live virus or bacteria. If you have a weakened immune system, which you may do during chemotherapy, they could be harmful.
It is safe to have these vaccines six months after your chemotherapy finishes. Talk to your GP or treatment team before having any vaccinations.
If someone you have close contact with needs to have a live vaccine, speak to your treatment team or GP. They can advise what precautions you may need to take depending on the vaccination.
Coronavirus (Covid-19) vaccination
People having chemotherapy are advised to speak to their treatment team before having the coronavirus (Covid-19) vaccination.
Anyone at risk of a weakened immune system, and therefore more prone to infection, should have the flu vaccine. This includes people due to have, or already having, chemotherapy.
The flu vaccine is not a live vaccine so does not contain any active viruses. Talk to your chemotherapy specialist or breast care nurse about the best time to have your flu jab.
7. Further support
Being diagnosed with breast cancer can make you feel lonely and isolated. You might find it helpful to visit our online forum.
If you would like any further information and support about breast cancer, or just want to talk things through, you can speak to one of our experts by exploring our contact options below.