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Capecitabine (Xeloda®) for pancreatic cancer

There are different chemotherapy drugs used to treat pancreatic cancer. Capecitabine is normally given with another chemotherapy drug called gemcitabine  – this is known as GemCap.

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Each hospital may do things slightly differently, and treatment will vary depending on your cancer. Speak to your doctor or nurse about your treatment.

How is capecitabine used?

GemCap can be used in different ways:

  • If you have cancer that can be removed with surgery (such as the Whipple’s procedure), you may be offered GemCap after surgery to try stop the cancer coming back.       
  • If you have borderline resectable cancer, you may have GemCap to try to shrink the cancer to make surgery possible. We need more research into this, and you may be offered GemCap before surgery as part of a clinical trial.    
  • If you have locally advanced or advanced pancreatic cancer and surgery is not possible, you may be offered GemCap to try to control the growth of the cancer.   

If you have advanced pancreatic cancer you may be offered capecitabine on its own, but this isn’t used often and is only given if you have already had gemcitabine treatment.

Capecitabine and radiotherapy

Some people with borderline resectable or locally advanced pancreatic cancer have radiotherapy together with chemotherapy. This is called chemoradiotherapy.    

If you have chemoradiotherapy, the chemotherapy drug that is normally used is capecitabine. The chemotherapy may make the cancer cells more sensitive to the radiotherapy, making it more effective. 

How is capecitabine given? 

Capecitabine is taken as a tablet that you take twice a day. You will need to take these tablets 12 hours apart, and you can take them at home just after eating a meal. Your chemotherapy team can tell you more about taking capecitabine.

If you find it hard to swallow tablets, or are sick just after taking them, contact your chemotherapy team for advice. Don’t cut or crush your capecitabine tablets without talking to your chemotherapy team.

GemCap chemotherapy

If you are having capecitabine with gemcitabine (GemCap), this is given in a four-week cycle. This means that you will have treatment for three weeks, and then have a break for one week. This break allows your body to recover between treatments. The number of GemCap cycles you have will depend on how the treatment is working and how chemotherapy affects you. Your chemotherapy team can tell you more about this.

You will take the capecitabine tablets every day, twice a day, for three weeks. You will also have gemcitabine once a week, through an infusion which takes 30 minutes. You may hear an infusion called a drip.  

Capecitabine and radiotherapy

If you are having capecitabine with radiotherapy, you will take capecitabine tablets on the days that you have radiotherapy. For example, you may have capecitabine and radiotherapy every day of the week (Mon-Fri), and then have a break from treatment at the weekend. Speak to your doctor or nurse about your treatment.  

What are the side effects of capecitabine?

Capecitabine can cause side effects, but these can affect everyone differently, and you may not get all of the side effects mentioned here. Your chemotherapy team should tell you about possible side effects and how they are managed. Ask them any questions you have. You can also speak to our specialist nurses on our free Support Line.

DPD-deficiency

Capecitabine is broken down in the body by an enzyme called dihydropyrimidine dehydrogenase (DPD). Some people have lower amounts of the DPD enzyme – which is known as DPD-deficiency. People with DPD-deficiency can have side effects that are much worse than usual. These include infections, runny poo (diarrhoea) and feeling or being sick. It is important to speak to your chemotherapy team if you think you may have DPD deficiency, or would like to know more about it.

Your chemotherapy team should give you an emergency number to call if you are unwell, or if you need information about any side effects. Your nurse will explain when to use this number. If you haven’t been given a number, ask your nurse about this.

Common side effects

Infection. Capecitabine can increase your risk of getting an infection. An infection is an emergency if you are having chemotherapy, and needs treating straight away. Read more about the signs of an infection, and how they are treated.

Fatigue (extreme tiredness). Fatigue is a common side effect of capecitabine. It isn’t the same as feeling tired. Fatigue can make you feel weak and have problems concentrating. Some people find that the fatigue starts a few hours to a few days after having chemotherapy, and starts to get better after a few days. There are things that you can do to help with fatigue. Read our tips on coping with it.

Feeling or being sick (nausea or vomiting). This is a common side effect of capecitabine. You will normally be given anti-sickness medicines before your chemotherapy starts. If these medicines don’t help, speak to your chemotherapy team about changing to a different medicine. Read our tips on coping with feeling and being sick. 

If you find it hard to swallow the capecitabine tablets, or you are sick just after taking them, call your chemotherapy team for advice.

Sore hands and feet. Capecitabine can make the palms of your hands and the soles of your feet red and sore, and your skin may start to peel or blister. Your skin might also look shiny, feel tight and crack around the fingertips. Your doctor or nurse may give you a vitamin or creams to help with this. The soreness normally gets better when your chemotherapy finishes.  

Sore mouth and mouth ulcers. Capecitabine can make your mouth sore, or cause mouth ulcers which can be painful. Tell your chemotherapy team about any problems with your mouth. They can make sure you don’t have a mouth infection, and give you a mouthwash which should help.

Loss of appetite. During your treatment you may not feel like eating, and you may start to lose weight. Try eating small meals often. If your appetite doesn’t get better after a few days, speak to your doctor or dietitian. We have tips on dealing with a loss of appetite.

Runny poo (diarrhoea). If you have diarrhoea, make sure you drink lots of water. If you have it more than four times a day, tell your chemotherapy team. They can give you medicines to control it. You may be told to stop taking capecitabine, or your doctor can lower the dose. We have tips of dealing with diarrhoea.

Tummy pain. You may have some tummy pain or discomfort when you are having capecitabine. Or you may have indigestion, lots of wind or feel bloated. You may also have trouble emptying your bowels (constipation). Your doctor can give you medicines to help with these side effects.  

Swelling (oedema). Some people get swelling in their feet, ankles, legs, fingers or face. This is because of a build-up of fluid, which is called oedema. This normally gets better by itself. If you have swelling in your feet, it may help to have your legs up on a cushion when you are sitting down. Your doctor may also be able to give you some medicines to help.

Anaemia (feeling tired or dizzy). Capecitabine can lower the number of red blood cells in your blood. This is called anaemia, and can make you feel tired, dizzy or short of breath.

Less common side effects

  • Bruising and bleeding. Capecitabine can lower the number of platelets in your blood – this is called thrombocytopenia. This can cause you to bruise more easily than normal, and you may be more likely to have nosebleeds or bleeding gums. 
  • Joint and muscle pain. Capecitabine can cause problems with your joints, such as swelling or pain. Your muscles may also feel weak or stiff.
  • Heart problems. Capecitabine can cause chest pain. It can also make you feel short of breath, dizzy, or cause an irregular heartbeat. It is important to call your chemotherapy team straight away if you have any of these symptoms, or go to A&E.
  • Sore, itchy eyes. Capecitabine can cause sore, itchy or watery eyes. Tell your doctor or nurse if this happens, as they may need to give you some eye drops.
  • Headaches. Capecitabine can cause headaches. Tell your chemotherapy team if you have headaches, so that they can give you painkillers such as paracetamol or ibuprofen to help.
  • Risk of a blood clot in a vein. Capecitabine can increase your risk of getting a blood clot in a vein. If you have any pain or swelling in one of your arms or legs, or you feel very short of breath, call you chemotherapy team straight away, or phone an ambulance. A blood clot can be serious if it isn’t treated.

Speak to your chemotherapy team if you feel anything unusual, or if you would like more information. You can also speak to our specialist nurses on our free Support Line about capecitabine and side effects.

Read more information

Read about how chemotherapy is given.

Read about managing the side effects of chemotherapy.

Read about coping with chemotherapy.

Read about other chemotherapy drugs for pancreatic cancer.

Updated August 2019

Review date August 2021