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Cisplatin and capecitabine (CX)

CX is the name of a chemotherapy combination. It includes the drugs:

  • cisplatin
  • capecitabine (Xeloda)

It is a treatment for a number of different types of cancer. 

How CX works

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How you have CX

You have:

  • cisplatin as a drip into your bloodstream
  • capecitabine comes as a tablet that you swallow whole, with plenty of water. You take twice a day, within 30 minutes of finishing a meal

Taking your tablets

You must take tablets according to the instructions your doctor or pharmacist gives you.

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

Into your bloodstream

You can have the drug through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Or you might have it through a long line: a central line, a PICC line or a Portacath.

These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.

When you have CX

You have CX chemotherapy as cycles of treatment, each lasting 3 weeks. Depending on your needs, you might have up to 6 cycles, taking around 5 months in total.

You might have each cycle of treatment in the following way:

Day 1
  • fluids as a drip to hydrate you for 1 hour into your bloodstream
  • cisplatin as a drip for 1 to 4 hours into your bloodstream
  • more fluids as a drip to hydrate you for a further 2 hours
  • take capecitabine tablets morning and evening
Days 2 to 14
  • continue to take capecitabine tablets morning and evening
Days 15 to 21
  • you have no treatment

Then you start the cycle again.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.

When to contact your team

Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your advice line or your doctor or nurse immediately if you have signs of infection, such as a temperature above 37.5C or below 36C, or if you develop a severe skin reaction. Signs of a severe skin reaction include peeling or blistering of the skin.

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include: 

Increased risk of getting an infection 

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale 

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nosebleeds 

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. 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, weakness (fatigue) during and after treatment

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.

Loss of appetite 

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Diarrhoea 

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days. Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Sore or dry mouth and ulcers 

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Soreness, redness and peeling on palms and soles of feets 

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Changes in levels of minerals in your blood 

You may have changes in levels of minerals and salts in your blood, including low levels of sodium or high levels of uric acid (causing gout). You have regular blood tests during treatment to check this.

Kidney damage 

To help prevent kidney damage, it is important to drink plenty of water. You might also have fluids into your vein before, during and after treatment. You have blood tests before your treatments to check how well your kidneys are working.

Changes to your hearing

You might have some hearing loss, especially with high pitched sounds. You might also have some ringing in your ears (tinnitus). Tell your doctor or nurse if you notice any changes.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • changes in heart rhythm - you may have a heart trace (ECG) before and during your course of treatment
  • hair loss - this is usually mild and grows back once treatment has finished
  • skin and hair problems such as a rash, dry or itchy skin and brittle nails - talk to your doctor or nurse about any changes to your skin
  • changes to your liver, picked up on a blood test
  • pain in your joints, back, chest, legs and arms
  • depression - talk to your nurse if you have a change in mood
  • difficulty sleeping
  • breathing problems such as a cough, shortness of breath and inflammation of your lung tissue (pneumonia) - tell your doctor if you have any shortness of breath
  • swelling and pain around the drip site - chemotherapy can damage the tissue so tell your nurse if you have any stinging, pain, redness or swelling
  • constipation - drink plenty and eat foods high in fibre. Your nurse can give you laxatives to help if needed
  • lack of fluid in your body (dehydration)
  • weight loss
  • loss of taste or metallic taste in your mouth
  • numbness or tingling usually in your fingers or toes
  • eye problems such as watery eyes, or sore or red eyes
  • headaches and dizziness - let your doctor or nurse know if you have these side effects

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include: 

  • allergic reaction that can cause a skin rash, itching and redness of the skin
  • a fatty lump under the skin (lipoma)
  • changes in blood sugar levels (diabetes)
  • angina or a heart attack - call 999 if you have chest pain
  • low levels of albumin in your body that can cause swelling and weakness
  • yellowing of the skin and eyes (jaundice)
  • feeling stiff or muscle weakness
  • fits (seizures)
  • confusion or memory problems
  • a small risk of developing a secondary cancer some years after treatment
  • a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening
  • a blood clot in the deep veins of your body (deep vein thrombosis, DVT) that could possibly travel to your lungs (pulmonary embolism). This could be life threatening if not treated quickly

Symptoms of a blood clot includes:

  • pain, redness and swelling around the area where the clot is and may feel warm to touch
  • breathlessness
  • pain in your chest or upper back – dial 999 if you have chest pain
  • coughing up blood
Tell your doctor immediately or go to A&E if you have any symptoms of a blood clot.

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drinks 

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception 

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Fertility

You may not be able to become pregnant or father a child after treatment with these drugs. 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. Women may be able to store eggs or ovarian tissue but this is rare.

Breastfeeding 

Don’t breastfeed during this treatment and for 2 weeks after your final treatment. This is because the drug may come through into your breast milk.

DPD deficiency 

Treatment for other conditions

Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called DPD in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine. These side effects can rarely be life threatening. It doesn’t cause symptoms so you won’t know if you have a deficiency. Talk to your doctor if you are worried and about whether you need to have a test to check for it. 

Contact your doctor if your side effects are severe.

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)
  • be in contact with other people who have had live vaccines as injections

Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened. 

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Last reviewed: 
12 Mar 2019
  • Electronic Medicines Compendium 
    Accessed March 2019 

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination
    Public Health England
    First published: March 2013 and regularly updated on the Gov.UK website

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