Oxaliplatin and capecitabine

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 and is made up of the drugs

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

The links above take you to more information about the individual side effects of each of these drugs.

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 drug directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

Capecitabine comes as peach coloured tablets. You take them twice a day. Your doctor will tell you which dose you need. Swallow them whole, with plenty of water, within 30 minutes of finishing a meal. 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 twice a day for 2 weeks. You then have a week with no treatment. After that you start the next treatment cycle. 

The side effects of a combination of drugs are usually a mixture of those of each drug. You may get 1 or 2 or a few of the effects. The combination may increase or decrease your chance of getting each side effect or it may change the severity. The 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.

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

A temporary drop in the number of blood cells made by the bone marrow, causing

• 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, sore throat, pain passing urine or feel cold and shivery
• 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, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue (tiredness) 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%) but is usually well controlled with anti sickness medicines
• Numbness or tingling in fingers and toes affects more than 8 out of 10 people (80 %) 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
• Diarrhoea occurs in around 1 in 2 people (50%) and can be quite severe but is usually well controlled with medicines – drink plenty of fluid and tell your doctor or nurse immediately if diarrhoea becomes severe, or continues for more than 2 days. Make sure you follow any special advice you have been given about how to cope with diarrhoea
• 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) which may cause tingling, numbness, pain and dryness
• Constipation affects 2 out of 10 people (20%) - your doctor may give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days
• These drugs have a harmful effect on a developing baby – do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant

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

• Women may stop having periods (amenorrhoea), but this may only be temporary
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if having a baby is important to you
• Hair loss and hair thinning or hair thinning may occur
• Headaches and dizziness
• Eye problems, including increased production of tears and infections
• 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 course of treatment
• Difficulty swallowing or breathing can be triggered by cold air in the first 5 days after you have oxaliplatin but 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

Fewer than 1 in 100 people have these.

• 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
• Ringing in the ears (tinnitus) affects about 1 in 100 people (1%) who have oxaliplatin and usually gets better after the treatment is over
• Chest pain and swelling of the ankles may occur with capecitabine
• Some people have an allergic reaction while having oxaliplatin, usually at the first or second treatment – let your treatment team know immediately if you have any skin rashes, itching, feeling hot, shivering, going red in the face, feeling dizzy, headache, shortness of breath, anxiety or a sudden need to pass urine

Not everyone will get these side effects. You may have none or several. 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

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

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

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.