Capecitabine (Xeloda) is new oral chemotherapy for colorectal cancer treatment. How to use Xeloda correctly? How to combine Xeloda with other chemotherapy medications in colon cancer treatment?
Stage three colon cancer treatment. Stage three colon cancer is defined by known involvement of lymph nodes in colorectal cancer. Dr. Anton Titov, MD. But there are no identified colon cancer metastases in stage 3 colon cancer. Dr. Anton Titov, MD. What is the best current treatment methods for stage 3 colon cancer? What are the nuances or controversies in stage 3 colon cancer treatment? Prof. Dr. Hans-Joachim Schmoll, MD. First of all, stage 3 colon cancer treatment must start with optimum surgery. Method and extent of surgery must be adapted to the local stage of tumor. Dr. Anton Titov, MD. Surgical operation should be as minimal as possible. in particular, surgeon must remove more than twelve lymph nodes during primary tumor resection. This is often not done in many operations and in many hospitals around the world. Prof. Dr. Hans-Joachim Schmoll, MD. Because we need to confirm the stage of colon cancer by examining enough lymph nodes. Stage 2 colon cancer means no lymph node involvement. Stage 3 colorectal cancer means lymph node involvement. Establishing stage of cancer with certainty is highly relevant for prognosis. Sometimes we confirm lymph node involvement, it is stage 3 colon cancer. Then we give to patient prophylactic chemotherapy. Prophylactic chemotherapy for stage 3 colon cancer is not targeted treatment for now. It is classical "doublet" chemotherapy. We use 5-Fluorouracil and oxaliplatin. Prof. Dr. Hans-Joachim Schmoll, MD. We did clinical trials to test addition of the third chemotherapy medication. This targeted chemotherapy is Bevacizumab . It targets blood vessels of the tumor. But Bevacizumab did not work well. Two medications are used. 5-Fluorouracil and oxaliplatin. Stage 3 colon cancer patient receives combination of 5-Fluorouracil and oxaliplatin for 4 to 6 months. Goal of therapy is to increase overall survival of patients. Addition of oxaliplatin to 5-Fluorouracil cures additional 5% of stage 3 colorectal cancer patients. This means 5 more out of 100 stage 3 colon cancer patients will be cured by oxaliplatin if it is added to 5-FU. Stage 3 colon cancer patients take both oxaliplatin and 5-Fluorouracil. This increases cure rate by 10% to 15% compared with no chemotherapy at all. many Stage 3 colon cancer patients are cured by this adjuvant combination chemotherapy after surgery. How to administer 5-Fluorouracil for maximum effect? Prof. Dr. Hans-Joachim Schmoll, MD. One option is bolus injection. Another option is continuous infusion for 24 or 48 hours every 2 weeks. This means making a special IV infusion "port" in a patient. Also pump is used to administer the chemotherapy. It is very uncomfortable for the patient. Also it is hard to control administration of chemotherapy if there patient experiences side effects. therefore patients have started research program 10 or 15 years ago. Its goal is to substitute intravenous 5-Fluorouracil infusion with oral route of administration. Prof. Dr. Hans-Joachim Schmoll, MD. This orally-administered 5-Fluorouracil derivative medication. It is a pro-medication. It is called Capecitabine . Another name for Capecitabine is UFT. But most oncologists use the name Capecitabine or Xeloda. We did an international clinical trial of Xeloda in 1,900 patients with stage 3 colon cancer. Prof. Dr. Hans-Joachim Schmoll, MD. We discovered that oral chemotherapy based combination of Capecitabine and oxaliplatin had similar efficacy with intravenous administration of 5 fluorouracil. Capecitabine was significantly better than single-agent chemotherapy with 5-fluorouracil in stage 3 colon cancer patients. Capecitabine had less side effects. Oral administration of Capecitabine was easy. Capecitabine also worked well in elderly patients over the age of 70. Capecitabine is an easy treatment. There is no need for infusions, intravenous ports ports or pumps. Capecitabine chemotherapy results are replicable. In my opinion Capecitabine should be the standard of care for stage 3 colorectal cancer. Prof. Dr. Hans-Joachim Schmoll, MD. Because oral Capecitabine has the same efficacy as intravenous 5-fluorouracil. Clinical trial had 10 years of follow up after treatment. results are very reliable. Oral medication capecitabine (Xeloda) is equally Effective as Infusion of 5-fluorouracil. Prophylactic chemotherapy for stage 3 colon cancer is not targeted treatment. 5-Fluorouracil and oxaliplatin are often used in combination. How to administer 5-Fluorouracil for maximum effect? Maintenance treatment with capecitabine plus bevacizumab (Avastin) after induction treatment in stage 3 colon cancer can be very effective. 5-Fluorouracil cures additional 5% of stage 3 colorectal cancer patients. Capecitabine (Xeloda) was significantly better than single-agent chemotherapy with 5-fl Xeloda effectiveness has been proven in several clinical trials in stage 3 and stage 4 colorectal cancer. Colon cancer stage 4 treatment by multimodal chemotherapy and locoregional therapy of liver and lung metastases. Leading colorectal cancer expert discusses capecitabine (Xeloda) combination chemotherapy in colon cancer.