XELIRI (Irinotecan and capecitabine)

Xeliri is the name of a combination of chemotherapy drugs used to treat advanced bowel cancer (colorectal cancer). This treatment is made up of the drugs

• Irinotecan (also called Campto)
• Capecitabine (also called Xeloda)

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

The side effects of a combination of drugs are usually a mixture of those of each drug. You may get some or all of the side effects. The combination may increase or decrease your chance of getting each side effect or it may change the severity. The side effects associated with irinotecan and capecitabine chemotherapy are listed below. You can use the underlined links to find out more about each one. For general information, see our cancer drug side effects section.

Irinotecan is a clear yellow fluid that you have through a drip (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 plastic tube put into your chest, called a central line, PICC line or portacath. These lines give the drugs directly into a major vein in the chest. They stay in throughout your course of treatment.

Capecitabine is peach coloured tablets. You take them twice a day. Your doctor will tell you which dose you need to take. Swallow them whole, with plenty of water, within 30 minutes of finishing a meal. Store the tablets in a cool, dry place out of the reach of children.

You have irinotecan and capecitabine chemotherapy as cycles of treatment. You usually have the treatment for as long as it controls your cancer. Each cycle lasts 3 weeks.

On the first day you have a 30 minute drip (infusion) of irinotecan and begin taking capecitabine tablets twice a day. You continue to take the capecitabine tablets for 2 weeks. For the last week you have no treatment. You then start your next treatment cycle.

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

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 hospital 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

• Increased sweating
• Increased saliva production – you will have a drug called atropine before the irinotecan to help reduce this
• Watery eyes
• Abdominal cramps
• Diarrhoea – this can occasionally be severe on the day you have treatment and for a day or so afterwards. You will have anti diarrhoea medicine to take at home if you need it. Make sure you follow any special advice you have been given about how to cope with diarrhoea. Contact your specialist immediately if you are worried or if the diarrhoea goes on for more than 48 hours.
• Fatigue (tiredness) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Feeling or being sick is usually well controlled with anti sickness drugs but let your doctor or nurse know if sickness is not controlled
• Loss of appetite
• A sore mouth
• Complete hair loss affects most people with these drugs but some people just have hair thinning
• Some people develop soreness, redness and peeling on the palms of the hands and soles of the feet (palmar-plantar syndrome) which may cause tingling, numbness, pain and dryness
• These drugs may have a harmful effect on a developing baby – do talk to your doctor or nurse 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.

• Irinotecan can sometimes cause muscle cramps
• Irinotecan can temporarily change how well your liver works – you will have regular blood tests to check this
• Skin rashes, which may be itchy
• Higher levels of bilirubin in your blood – you will have regular blood tests to check your bilirubin levels
• Constipation may occur with capecitabine but is usually well controlled with laxatives – tell your doctor or nurse if you are constipated for more than 3 days
• Headaches and dizziness with capecitabine
• Eye problems with capecitabine, including increased production of tears and eye infections
• Women may stop having periods (amenorrhoea) – this may be temporary
• Loss of fertility – we don’t know exactly how these drugs affect fertility so do talk with your doctor before starting treatment if having a baby is important to you

Fewer than 1 in 100 people have these.

• Swollen ankles
• Temporary chest pain

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. Your nurse will give you a contact number. 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.