Authors' results and conclusions: Capecitabine is an oral administered drug, which has been evaluated as a therapeutic alternative for colorectal cancer patients. There is evidence based on randomized clinical trials (RCTs) to evaluate its indication in metastatic colorectal cancer. Capecitabine is a therapeutic option specially for first-line treatment (its efficacy is similar to that of intravenous alternatives with 5 Fluorouracile [5-FU] and folinic acid [leucovorine, FA] but different in its side effects profile). Despite these RCTs-based facts, there is evidence suggesting that other 5-FU/FA infusion protocols other than those used in the trials show more effectiveness and less toxicity, consequently it is likely that capecitabine is less effective than 5-FU/FA administered with these protocols (specifically the one evaluated at Mayo Clinic). A RCT is required to directly compare oral treatment with the different infusion regimens to clear this question up. Currently, capecitabine is covered by the English health system for the already mentioned indication and it is also covered in the United States by the pre-paid medicine systems and MEDICARE (health system specially for elder people). Though cost-effectiveness studies support its use in England, there are no economic assessments locally. The decision about this treatment should be jointly made by the treating physician(s) and the individual. It has to be made after an informed discussion between parties taking into account contraindications, agent s side effects, alternative therapies as well as patient preferences and medical condition. Capecitabine must be used by oncologists specialized in the pathology to be treated.

Authors' recommendations: In summary, capecitabine could be a therapeutic option for patients with metastatic colon cancer even though its efficacy is similar to that of conventional therapies such as 5-FU/FA. In these cases, the capecitabine s main comparative advantage would be its easy oral administration and a different side effect profile (a little lower incidence of nausea, diarrhea, stomatitis and neutropenia but a higher incidence of hand-foot syndrome and hyperbilirubinemia). However, it is possible that capecitabine shows a lower effectiveness than other 5-FU/FA infusion regimens used; consequently its indication is yet to be carefully considered.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)