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World J Gastrointest Oncol. Aug 15, 2010; 2(8): 311-321
Published online Aug 15, 2010. doi: 10.4251/wjgo.v2.i8.311
Capecitabine for locally advanced and metastatic colorectal cancer: A review
Georgios V Koukourakis, Georgios Zacharias, John Tsalafoutas, Dimitrios Theodoridis, Vassilios Kouloulias
Georgios V Koukourakis, Department of Radiation Oncology, Anticancer Institute of Athens “Saint Savvas”, Athens, Greece
Georgios Zacharias, Section of Intensive Therapy, General Hospital of Corinth, Corinth, Greece
John Tsalafoutas, Department of Radiation Physics, Anticancer Institute of Athens “Saint Savvas”, Athens, Greece
Dimitrios Theodoridis, Department of Laboratory Medicine, “Saint Olga” General Hospital of Athens, Athens, Greece
Vassilios Kouloulias, Section of Radiation Oncology, University Hospital of Athens “ATTIKON”, Athens, Greece
Author contributions: Koukourakis GV did the literature research and wrote this paper; Zacharias G contributed to the writing; Theodoridis D assisted in the literature research; Tsalafoutas J corrected the language and Kouloulias V contributed to article analysis and had the idea for this paper, all authors have read and approved the paper.
Correspondence to: Georgios V Koukourakis, MD, PhD, Senior of Radiation Oncology, Anticancer Institute of Athens “Saint Savvas”, Athens, Greece. gkoyokoyrakis@yahoo.gr
Telephone: +30-21-6409421 Fax: +30-21-6420418
Received: February 21, 2010
Revised: July 30, 2010
Accepted: August 6, 2010
Published online: August 15, 2010

Capecitabine (Xeloda®) is an oral fluoropyrimidine which is produced as a pro-drug of fluorouracil, and shows improved tolerability and intratumor drug concentrations following its tumor-specific conversion to the active drug. We have searched the Pubmed and Cochrane databases from 1980 to 2009 with the purpose of reviewing all available information on Capecitabine, focusing on its clinical effectiveness against colorectal cancer. Special attention has been paid to trials that compared Capecitabine with standard folinic acid (leucovorin, LV)-modulated intravenous 5-fluorouracil (5-FU) bolus regimens in patients with metastatic colorectal cancer. Moreover the efficacy of Capecitabine on metastatic colorectal cancer, either alone or in various combinations with other active drugs such as Irinotecan and Oxaliplatin was also assessed. Finally, neoadjuvant therapy consisting of Capecitabine plus radiation therapy, for locally advanced rectal cancer was analysed. This combination of chemotherapy and radiotherapy has a special role in tumor down staging and in sphincter preservation for lower rectal tumors. Comparative trials have shown that Capecitabine is at least equivalent to the standard LV-5-FU combination in relation to progression-free and overall survival whilst showing a better tolerability profile with a much lower incidence of stomatitis. It is now known that Capecitabine can be combined with other active drugs such as Irinotecan and Oxaliplatin. The combination of Oxaliplatin with Capecitabine represents a new standard of care for metastatic colorectal cancer. Combinating the Capecitabine-Oxaliplatin regimen with promising new biological drugs such as Bevacizumab seems to give a realistic prospect of further improvement in time to progression of metastatic disease. Moreover, preoperative chemo-radiation using oral capecitabine is better tolerated than bolus 5-FU and is more effective in the promotion of both down-staging and sphincter preservation in patients with locally advanced rectal cancer. Finally, the outcomes of recently published trials suggest that capecitabine seems to be more cost effective than other standard treatments for the management of patients with colorectal cancer.

Keywords: Chemo-radiotherapy, Colorectal cancer, Capecitabine, Oxaliplatin, Xeloda