Real-World Adverse Effects of Capecitabine Toxicity in an Elderly Population

Abstract

BackgroundFew studies have assessed the safety and effectiveness of the numerous available chemotherapeutic therapies for geriatric oncology patients. Most safety studies are conducted in large trials, and there is some uncertainty surrounding whether the results would be the same in typical daily use.ObjectiveThis retrospective study aims to assess the adverse effects of real-world capecitabine use in elderly patients.MethodsWe reviewed the records of patients treated with capecitabine in an oncology department of a University Clinic in Nijmegen, The Netherlands. We scored adverse effects such as hand-foot syndrome and diarrhea, and dosage adjustments and the reasons for them. In total, 132 patients were included, 69 of whom were aged 70 years or below (mean age: 57 years), while 63 were aged older than 70 years (mean age: 74 years).ResultsPatients aged over 70 years experienced more serious adverse effects than younger patients. Grade 2 or 3 hand-foot syndrome toxicity was experienced by 20.2% of patients aged younger than 70 years and by 34.9% of patients older than 70 years (p = 0.059). Grade 2, 3, or 4 diarrhea was experienced by 17.4% of the patients aged younger than 70 years but by 31.7% of the patients aged older than 70 years (p = 0.044). Dosage was adjusted for 27/69 patients in the younger group and 52/63 patients in the older group (p = 0.001).ConclusionThe difference in observed adverse effects cannot be the sole explanation for the high incidence of observed dose adjustments. A prospective follow-up study of elderly patients using capecitabine outside clinical trials is needed to evaluate the optimum balance between adverse effects and efficacy.

Tolerance to oral anticancer agent treatment in older adults with cancer: a secondary analysis of data from electronic health records and a pilot study of patient-reported outcomes

“…The percentage of older adults who reported moderate-severe fatigue in this study (about 40%) was higher than that reported in the literature (about 25%) [ 29 ]. However, the number of older adults who rated their HFS as severe or extremely severe in this study (7%) was lower than those reported in a previous randomized controlled trial or a chart review study (21%) [ 30 , 31 ]. Such differences may be because of proactive HFS monitoring and management strategies in clinical practice or the small sample of older adults (n = 43, 44%) with a limited representation.…”

Tolerance to oral anticancer agent treatment in older adults with cancer: A secondary analysis of data from EHRs and a pilot study of patient-reported outcomes

“…The number is higher than what a previous study has reported that 25% of patients rated their fatigue as moderate-severe when taking oral chemotherapy [27]. While 7% of older adults rated their HFS as severe or extremely severe in the current study, this was less than 21% older adults reported in a previous randomized controlled trial [28], and 11% of older adults aged older than 70 years reported in a chart review study [29]. Such differences may be because the sample size of the current study was small, and the sample of participants aged 65 years and above was limited.…”

Hand-foot syndrome in cancer patients on capecitabine: examining prevalence, impacts, and associated risk factors at a cancer centre in Malaysia

“…In addition, consistent with other studies [ 22 , 23 ], our study showed a significant association between HFS and increasing age. Older patients often present with pre-existing comorbidities and are prescribed with multiple concurrent medications [ 22 , 24 ]. Furthermore, a study showed that elderly patients may have reduced drug clearance, leading to higher capecitabine exposure compared to younger individuals [ 25 ].…”