Capecitabine Pattern of Usage, Rate of Febrile Neutropaenia and Treatment Related Death in Asian Cancer Patients in Clinical Practice

Background: Oral capecitabine is increasingly replacing intravenous 5-fluorouracil in many chemotherapyregimens. However, data on the risk of febrile neutropaenia (FN) and treatment related death (TRD) with thedrug remain sparse outside of clinical trial settings despite its widespread usage. This study aimed to determinethese rates in a large cohort of patients treated in the University of Malaya Medical Centre (UMMC). Materialsand
Methods: We reviewed the clinical notes of all patients prescribed with oral capecitabine chemotherapyfor any tumour sites in University Malaya Medical Centre (UMMC) from 1st January 2009 till 31st June 2010.Information collected included patient demographics, histopathological features, treatment received including thedifferent chemotherapy regimens and intent of treatment whether the chemotherapy was given for neoadjuvant,concurrent with radiation, adjuvant or palliative intent. The aim of this study is to establish the pattern of usage,FN and TRD rates with capecitabine in clinical practice outside of clinical trial setting. FN is defined as an oraltemperature >38.5°C or two consecutive readings of >38.0°C for 2 hours and an absolute neutrophil count <0.5 x109/L, or expected to fall below 0.5 x 109/L (de Naurois et al., 2010). Treatment related death was defined as deathoccurring during or within 30 days of last chemotherapy treatment.
Results: Between 1st January 2009 and 30thJune 2010, 274 patients were treated with capecitabine chemotherapy in UMMC. The mean age was 58 years(range 22 to 82 years). Capecitabine was used in 14 different tumour sites with the colorectal site predominatingwith a total of 128 cases (46.7%), followed by breast cancer (35.8%). Capecitabine was most commonly usedin the palliative setting accounting for 63.9% of the cases, followed by the adjuvant setting (19.7%). The mostcommon regimen was single agent capecitabine with 129 cases (47.1%). The other common regimens were XELOX(21.5%) and ECX (10.2%). The main result of this study showed an overall FN rate of 2.2% (6/274). The overallTRD rate was 5.1% (14/274). The FN rate for the single agent capecitabine regimen was 1.6% (2/129) and theTRD rate was 5.4% (7/129). All the TRDs were with single agent capecitabine regimen were used for palliativeintent.
Conclusions: Oral capecitabine is used widely in clinical practice in a myriad of tumour sites and bearsa low risk of febrile neutropaenia. However, capecitabine like any other intravenous chemotherapeutic agentcarries a significant risk of treatment related death.