Bendigo Hospital provides cancer services to the Loddon-Mallee region in Victoria. 5-fluorouracil plus Leucovorin (5FU/LV) is administered intravenously in hospital whereas oral capecitabine is self-administered at home. Clinical trials show equivalent disease-free survival and overall survival rates between 5FU/LV and capecitabine, with similar rates of dose modifications and completion of planned treatment1. This audit aims to review the real-world experience of patients with stage II and III colorectal cancer treated with either capecitabine or 5FU/LV.
An audit of the medical records of patients treated with either capecitabine or 5FU/LV for stage II or III colorectal cancer between January 2007 and January 2017 at Bendigo Hospital was performed. The primary end-points include the rates of grade ≥ 3 adverse effects (AEs), dose modifications (delay, reduction or cessation) and hospital admissions.
126 patients with stage II or III colorectal cancer were identified. 16 versus 21 patients received either capecitabine or 5FU/LV respectively. A higher proportion of patients receiving capecitabine reported grade ≥ 3 AEs compared to those receiving 5FU/LV (63% versus 29%, p = 0.03). Common capecitabine AEs include diarrhoea and palmar-plantar erythema. Diarrhoea and nausea were common AEs of 5FU/LV. There was no difference in the proportion of patients requiring hospital admission or early cessation of chemotherapy. There was a numerically higher proportion of capecitabine treated patients requiring treatment delay (69% versus 43%, p = 0.19) and dose reduction (69% versus 33%, p = 0.92) compared to 5FU/LV, but this was not statistically significant.
Conclusion: Although capecitabine is convenient, especially for remote patients, more patients in Loddon-Mallee region experienced grade ≥ 3 AEs with capecitabine compared to 5FU/LV, with a numerically higher proportion of treatment delays and dose reductions. However, this did not translate to a statistical significant increase in hospital admissions or early cessation of chemotherapy.