Aim:
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.
Method:
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.
Results:
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.