Low-dose Metronomic Capecitabine (Xeloda) for Treatment of Metastatic Gastrointestinal Cancer: A Clinical Study

Background: Metastatic gastrointestinal cancer (GI-cancer) is often a chronic disease where the treatment intention often is palliative. For such patients, it is important to offer treatments that can prevent tumor progression without reducing quality of life more than necessary. Metronomic chemotherapy involves continuous administration of cytostatic drugs at low doses without longer drugfree intervals. Capecitabine (Xeloda) is a prodrug, given in a tablet formulation, that is selectively converted to 5-Fluorouracil at the tumor sites. In this study, we aimed to explore the efficacy and tolerability of metronomic Xeloda. Methods: Patients (n = 87) diagnosed with a primary metastatic or recurrent disease were included and retrospectively analyzed. Clinical data were obtained from patient journals. All patients had been treated with metronomic Xeloda (500 mg × 2). Primary endpoints were to investigate the two-year overall survival (OS) and the best response. Best response was evaluated by radiological and clinical examination. Standard RECIST criteria were used. Survival analysis was performed using the Kaplan-Meier method. Results: Regress stable disease and progress were seen in 13% (n = 11), 38% (n = 33) and 47% (n = 41) of the cases respectively. The two-year OS for the cohort was 56% and median OS was 26 months. The treatment was well tolerable and all reported side effects (n = 21) were of toxicity grade I or II. Conclusions: Our data show that metronomic Xeloda may offer a therapeutic alternative for highly motivated patients in a good general condition when evidence-based regimens are not considered suitable or have failed.