by Nabil Phillips, MD and Simon Madorsky, MD
Capecitabine, an oral chemotherapeutic drug, is a prodrug of 5-FU (fluorouracil) – the most widely used topical chemotherapeutic agent for basal and squamous cell carcinomas. Capecitabine is better known by its brand name Xeloda. Although the drug is currently FDA approved only for colon and breast cancer, it has been used for treatment of squamous cell carcinoma of the skin in two clinical settings. The first involves treatment of inoperable squamous cell carcinoma of the skin – either due to extent, location, or condition of the patient. These settings have been described in the literature as case reports only. Another setting for application of capecitabine has been recently studied and involves solid organ transplant recipients (SOTR). With the required immunosuppression, as the time post-transplant increases, so does the frequency of skin cancers. Recent clinical studies have tried to evaluate prophylactic use of capecitabine in decreasing the frequency and progression of skin cancers in SOTR patients. These Phase II studies are currently under way. In both of these settings – inoperable squamous cell carcinomas of skin and multiple squamous cell carcinomas of immunosuppressed transplant patients – the results have been encouraging if not impressive.
The simple advantage of capecitabine is its simple form of administration – oral, alternating 1-2 weeks on and 1 week off as a maintenance regimen. However, its drawbacks occasionally limit its tolerability and include hand-foot syndrome, diarrhea, and rarely neutropenia. The cost is also significant – $4,000 per month. Despite that, we have been successful in obtaining insurance approval for our patients.
