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Pill Makes Chemotherapy Easier to Swallow


WebMD Health News
Reviewed by Gary D. Vogin, MD

April 18, 2001 -- Colon cancer patients may soon take their chemotherapy in a pill, at home, rather than through an IV, at the hospital. Xeloda is a new oral formulation of 5-FU, the most commonly used colon cancer treatment. And in a recent clinical trial, it was just as effective as its intravenous counterpart, with far fewer side effects.

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The chemotherapy pill "is both convenient to use and produces fewer side effects, and that's a big attraction for patients. Given these results, patients slated to receive the chemotherapy drug 5-FU could consider receiving it in pill form rather than through an IV," said study leader Paulo M. Hoff, MD, in a written statement.

Hoff's international research team randomly assigned more than 600 advanced colon cancer patients to receive a standard course of Xeloda or traditional intravenous 5-FU plus another chemotherapy drug called Wellcovorin. Their findings are published in the April 15 issue of the Journal of Clinical Oncology.

About 25% of patients treated with Xeloda responded to therapy, meaning that their tumors shrank, compared with 16% of standard therapy patients. What's more, the Xeloda patients experienced significantly less diarrhea, nausea, gastrointestinal ulcers, and hair loss than did the group receiving standard therapy.

Inexplicably, the tumor shrinkage did not translate to longer life. Even so, says Hoff, "a good tumor response is reassuring for patients, and may ultimately benefit them." Because it is better tolerated than IV chemotherapy -- and can be taken in the comfort and privacy of a patient's own home -- the new pill may improve quality of life.

But Banke Agarwal, MD, who reviewed the research for WebMD, urges caution.

"These drugs can carry serious adverse reactions. If you're in the hospital, the doctor can identify and treat them, then and there. At home, a patient needs to know exactly what to look out for and what to do. This would require very good patient education," he tells WebMD. Agarwal is an assistant professor of medicine at the University of Texas M.D. Anderson Cancer Center in Houston.

Xeloda manufacturer Hoffman-La Roche Inc. provided partial funding for the study.

In a related investigation, another research group looked at several potential genetic markers for predicting which colon cancer patients will get the most benefit from 5-FU chemotherapy.

They analyzed the genetic make-up of tumor tissue taken from more than 300 people with advanced colon cancer and found that certain complex genetic changes were associated with a significantly better chance of surviving 5 years after treatment.

The findings need to be confirmed and the markers further clarified, but the study "is a first step toward the goal of individualized cancer treatment ..." the researchers write. Their complete report appears in the April 19 issue of The New England Journal of Medicine.

The real benefit will be seen "if they can come up with markers that predict, with 80-90% accuracy, that someone is likely to benefit," says Agarwal. "Chemotherapy comes with side effects. Often people are miserable because of the treatment, not the cancer. So you could use this test to strike a balance between when that's warranted and when it's not. Some people might be better off not taking the chemotherapy."

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