Georgios V Koukourakis, Department of Radiation Oncology, Anticancer Institute of Athens "Saint Savvas", Athens, Greece.
World J Gastrointest Oncol. 2010 Aug 15;2(8):311-21. doi: 10.4251/wjgo.v2.i8.311.
Capecitabine (Xeloda(®)) is an oral fluoropyrimidine which is produced as a pro-drug of fluorouracil, and shows improved tolerability and intratumor drug concentrations following its tumor-specific conversion to the active drug. We have searched the Pubmed and Cochrane databases from 1980 to 2009 with the purpose of reviewing all available information on Capecitabine, focusing on its clinical effectiveness against colorectal cancer. Special attention has been paid to trials that compared Capecitabine with standard folinic acid (leucovorin, LV)-modulated intravenous 5-fluorouracil (5-FU) bolus regimens in patients with metastatic colorectal cancer. Moreover the efficacy of Capecitabine on metastatic colorectal cancer, either alone or in various combinations with other active drugs such as Irinotecan and Oxaliplatin was also assessed. Finally, neoadjuvant therapy consisting of Capecitabine plus radiation therapy, for locally advanced rectal cancer was analysed. This combination of chemotherapy and radiotherapy has a special role in tumor down staging and in sphincter preservation for lower rectal tumors. Comparative trials have shown that Capecitabine is at least equivalent to the standard LV-5-FU combination in relation to progression-free and overall survival whilst showing a better tolerability profile with a much lower incidence of stomatitis. It is now known that Capecitabine can be combined with other active drugs such as Irinotecan and Oxaliplatin. The combination of Oxaliplatin with Capecitabine represents a new standard of care for metastatic colorectal cancer. Combinating the Capecitabine-Oxaliplatin regimen with promising new biological drugs such as Bevacizumab seems to give a realistic prospect of further improvement in time to progression of metastatic disease. Moreover, preoperative chemo-radiation using oral capecitabine is better tolerated than bolus 5-FU and is more effective in the promotion of both down-staging and sphincter preservation in patients with locally advanced rectal cancer. Finally, the outcomes of recently published trials suggest that capecitabine seems to be more cost effective than other standard treatments for the management of patients with colorectal cancer.
卡培他滨（希罗达(®)）是一种口服氟嘧啶类药物，在体内可转化为氟尿嘧啶，从而发挥作用。与标准的叶酸（亚叶酸，LV）调节的静脉注射氟尿嘧啶（5-FU）推注方案相比，卡培他滨具有更好的耐受性和肿瘤内药物浓度，因此我们检索了 1980 年至 2009 年期间的 PubMed 和 Cochrane 数据库，旨在综述卡培他滨的所有临床疗效信息，重点关注其在结直肠癌中的应用。特别关注了将卡培他滨与标准 LV-5-FU 方案比较的临床试验，包括转移性结直肠癌患者的临床试验。此外，还评估了卡培他滨单独或与伊立替康和奥沙利铂等其他活性药物联合治疗转移性结直肠癌的疗效。最后，分析了卡培他滨联合放化疗治疗局部进展期直肠癌的新辅助治疗。这种化疗联合放疗方案对于低位直肠肿瘤的肿瘤降期和保留肛门括约肌具有特殊作用。比较试验表明，卡培他滨在无进展生存期和总生存期方面与标准 LV-5-FU 方案至少等效，且具有更好的耐受性，口腔炎发生率明显降低。现在已经知道，卡培他滨可以与其他活性药物联合应用，如伊立替康和奥沙利铂。卡培他滨联合奥沙利铂已成为转移性结直肠癌的新标准治疗方案。联合应用卡培他滨-奥沙利铂方案和有前途的新型生物药物，如贝伐单抗，似乎有望进一步改善转移性疾病的进展时间。此外，与氟尿嘧啶推注方案相比，口服卡培他滨的术前放化疗耐受性更好，并且更有效地促进局部进展期直肠癌的降期和保留肛门括约肌。最后，最近发表的试验结果表明，卡培他滨在结直肠癌患者的管理方面似乎比其他标准治疗更具成本效益。
