To assess dosing, safety and tolerability of Capecitabine in patients aged ≥ 70 years old with gastrointestinal cancer.
A retrospective clinical chart review was undertaken of all patients aged ≥ 70 years old with gastrointestinal cancer who were started on Capecitabine as a sole chemotherapy drug between January 2012 and February 2017. These data were entered into a de-identified database.
A total of 77 patients were identified. Forty-six (59.7%) were male and 31 (40.3%) were female. Their ages ranged from 70 to 91 years old and the median age was 79 years old. Sixty-three (81.8%) patients had colorectal cancer, 13 (16.9%) had gastro-oesophageal cancer and one (1.3%) had appendiceal cancer. In 21 (27.3%) patients, Capecitabine was administered adjuvantly. Nineteen (90.5%) patients had upfront dose reduction. Capecitabine was administered palliatively in 56 (72.7%) patients. Fifty (89.3%) patients had an upfront dose reduction. Reasons include assessing tolerance (33.3%), poor functional status (11.6%) and renal impairment (7.2%). Only six (8.7%) had their doses increased later. Eighteen (26%) had further dose reductions. In those who started on full doses, six (75%) needed dose reductions later. Thirty-five (45.4%) patients had cycle delays. Main reasons documented include skin toxicity (25.4%), diarrhoea (11.9%) and fatigue (5.1%). In the adjuvant setting, only 10 (47.6%) patients completed adjuvant Capecitabine (eight cycles). Reasons for stopping earlier include cardiac-related toxicity (40.0%), patient preference (20.0%), diarrhoea (10.0%), skin toxicity (10.0%) and progressive disease (10.0%). In those with metastatic disease, none achieved complete remission, 13 (23.2%) achieved partial remission, 19 (33.9%) had stable disease and 14 (25.0%) did not respond at all. There were no Capecitabine-related deaths reported.
In patients ≥ 70 years old with gastrointestinal cancer, Capecitabine was safe was but poorly tolerated in full doses. Therefore, upfront dose reduction is reasonable in the elderly.