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Oxaliplatin and capecitabine

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This page tells you about the chemotherapy drug combination oxaliplatin and capecitabine and the possible side effects. There is information about

 

Oxaliplatin and capecitabine chemotherapy

Oxaliplatin and capecitabine is the name of a combination of chemotherapy drugs used to treat advanced stage bowel cancer (colorectal cancer). It is also called XELOX or CAPE-OX and is made up of the drugs

  • Oxaliplatin (also called Eloxatin)
  • Capecitabine (also called Xeloda)
 

How you have oxaliplatin and capecitabine

Oxaliplatin is a clear, colourless fluid that you have into your bloodstream (intravenously). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.

You can read our information about having chemotherapy into a vein.

Capecitabine comes as peach coloured tablets. You take them twice a day. Your doctor will tell you which dose you need. It is very important that you take tablets according to the instructions your doctor or pharmacist gives you. For example, whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream. Swallow the tablets whole, with plenty of water, within 30 minutes of finishing a meal. Take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first. Store the tablets in a cool, dry place away from the reach of children.

You usually have chemotherapy as cycles of treatment. You may have between 6 and 8 cycles. Each cycle lasts 3 weeks.

  • On the first day you have a 2 hour drip (infusion) of oxaliplatin and begin taking the capecitabine tablets twice a day
  • You usually continue to take capecitabine tablets for 2 weeks
  • You then have a week with no treatment
  • After that you start the next treatment cycle

The side effects associated with oxaliplatin and capecitabine combination chemotherapy are listed below. You can use the underlined links to find out more about each one. For general information, see our cancer drugs side effects section or use the search box at the top of the page.

 

Common side effects

More than 10 in every 100 people have one or more of the side effects listed below.

  • Numbness or tingling in fingers and toes affects more than 9 out of 10 people (90 %) and can cause difficulty with fiddly things such as doing up buttons – this starts within a few days or weeks and usually goes within a few months of finishing treatment. In the first few hours after having oxaliplatin this reaction may be triggered by cold
  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C. You will have regular blood tests to check your blood cell levels
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising more easily due to a drop in platelets – you may have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia)
  • Tiredness and weakness (fatigue) affects 6 out of 10 people (60%) during and after treatment. Most people find their energy levels are back to normal from 6 months to a year after their treatment ends
  • Feeling or being sick affects about 8 out of 10 people (80%) – it is usually well controlled with anti sickness medicines
  • Diarrhoea occurs in around 1 in 2 people (50%) and can be quite severe but is usually well controlled with medicines – drink plenty of fluids. Make sure you follow any special advice you have been given about how to cope with diarrhoea. Tell your doctor or nurse straight away if diarrhoea becomes severe or continues for more than 2 days
  • A sore mouth occurs in up to 4 out of 10 people (40%)
  • Loss of appetite affects 3 out of 10 people (30%)
  • Some people develop soreness, redness and peeling on the palms of the hands and soles of the feet (plantar-palmar syndrome). This may cause tingling, numbness, pain and dryness
  • Constipation affects 2 out of 10 people (20%) – your doctor or nurse may give you laxatives to help prevent this. Tell them if you are constipated for more than 3 days
 

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Hair loss and hair thinning
  • Headaches and dizziness
  • Eye problems, including increased production of tears and infections
  • Tummy (abdominal) pain
  • Raised amounts of a chemical called bilirubin in your blood – you will have regular blood tests to check your bilirubin levels during your treatment
  • Kidney changes occur in about 3 out of every 100 people (3%) with oxaliplatin – this is usually mild but you will have regular blood tests to check how well your kidneys are working
  • Difficulty swallowing or breathing can be triggered by cold air in the first 5 days after you have oxaliplatin. This usually clears up on its own. Tell your doctor or nurse if you have this side effect and avoid cold drinks or ice cubes for the first few days
  • Women may stop having periods (amenorrhoea) but this may be temporary
  • Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
 

Rare side effects

Fewer than 1 in 100 people have these.

  • Ringing in the ears (tinnitus) affects about 1 in 100 people (1%) and usually gets better after the treatment is over
  • Chest pain and swelling of the ankles
  • Some people have an allergic reaction while having oxaliplatin, usually at the first or second treatment. Let your treatment team know straight away if you have any skin rashes, itching, or swelling in the lips, face or throat
 

Important points to remember

You may have some of the side effects mentioned above. They may be mild or more severe. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

  • How many times you've had a drug before
  • Your general health
  • How much of the drug you have (the dose)
  • Other drugs you are having

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Pregnancy and contraception

These drugs may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Do not breastfeed during this treatment because the drugs may come through in the breast milk.

 

Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.

 

Related information

You can read our information about

Bowel cancer (colorectal cancer)

Oxaliplatin

Capecitabine

Taking medicines safely

 

More information about these drugs

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.

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Updated: 24 February 2015