Adverse Effects of Capecitabine Treatment in Cancer Patients

Capecitabine is an oral fluoropyrimidine prodrug widely employed in the management of colorectal, breast and gastric malignancies. While generally more convenient than intravenous 5-fluorouracil, it is associated with a spectrum of adverse effects that may limit its use or necessitate dose modifications. The gastrointestinal tract is most frequently affected, with diarrhoea, mucositis and, in severe cases, capecitabine-induced ileitis leading to dehydration, electrolyte disturbances and, occasionally, surgical intervention. Dermatological toxicity, typified by palmar-plantar erythrodysaesthesia or hand–foot syndrome, can impair quality of life and may force discontinuation. Haematological events include neutropaenia and anaemia, which heighten infection risk and may compromise treatment intensity. Less common but clinically significant complications encompass metabolic disturbances such as hypertriglyceridaemia, acute hyperglycaemia and hypokalaemia, as well as hepatotoxicity presenting as steatosis or acute liver injury. Cardiotoxicity and rare fatal multiorgan sequelae have also been documented. Individual susceptibility is influenced by pharmacogenetic factors—for instance, dihydropyrimidine dehydrogenase deficiency—and by age, comorbidities and combination regimens with radiotherapy or platinum compounds. Early recognition and proactive management are essential to mitigate morbidity, optimise dose intensity and ensure patient safety on a global scale.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Adverse Effects of Capecitabine Treatment in Cancer Patients publication trend

The graph below shows the total number of articles in adverse effects of capecitabine treatment in cancer patients across all publications each year (not limited to Nature Index journals).

Technical terms

Capecitabine: An oral prodrug converted enzymatically into 5-fluorouracil, used in adjuvant and metastatic settings for various solid tumours.

Dihydropyrimidine dehydrogenase (DPD): The principal enzyme responsible for catabolism of fluoropyrimidines; partial or complete deficiency increases risk of severe toxicity.

Hypertriglyceridaemia: Elevated serum triglyceride concentration that may precipitate acute pancreatitis and necessitates lipid-lowering interventions.

Ileitis: Inflammation of the ileum leading to severe diarrhoea, abdominal pain and potential intestinal perforation or bleeding.

Palmar-plantar erythrodysaesthesia (hand–foot syndrome): A cutaneous reaction characterised by redness, swelling and discomfort on the palms and soles, often dose limiting.

Hepatotoxicity: Liver injury manifesting as steatosis, transaminase elevation or acute liver failure, reversible upon cessation of the offending agent.

References

1. Capecitabine-Induced Ileitis during Neoadjuvant Pelvic Radio-Chemotherapy for Locally Advanced Rectal Cancer: A Case Report with Literature Review. Current Oncology (2023).
2. The frequency and severity of capecitabine-induced hypertriglyceridaemia in routine clinical practice: a prospective study. British Journal of Cancer (2010).
3. Capecitabine-Induced Terminal Ileitis: Case Report and Literature Review. Cureus (2021).
4. Capecitabine-induced severe diabetes and hypokalemia: a case report. Journal of Medical Case Reports (2022).
5. Hepatic steatosis secondary to capecitabine: a case report. Journal of Medical Case Reports (2010).
6. Severe and Late Acute Liver Injury Induced by Capecitabine. Cureus (2021).
7. Lethal cardiotoxicity, steatohepatitis, chronic pancreatitis, and acute enteritis induced by capecitabine and oxaliplatin in a 36-year-old woman. Diagnostic Pathology (2013).
8. Toxicity associated with capecitabine plus oxaliplatin in colorectal cancer before and after an institutional policy of capecitabine dose reduction. British Journal of Cancer (2010).