Why It's Called the "CAPEOX" Regimen

• CAPE stands for Capecitabine, an oral chemotherapy drug.

• OX stands for Oxaliplatin, an intravenous chemotherapy agent.

Purpose of the "CAPEOX" Regimen

• Colorectal Cancer: It is used in the adjuvant setting to reduce the risk of cancer recurrence after surgery and is also employed in the management of metastatic colorectal cancer.

• Gastric Cancer: Occasionally, CAPEOX may be considered for the treatment of advanced gastric cancer, especially in settings where combination chemotherapy is appropriate.

Key Components

1. Capecitabine (Xeloda):
• Class: Fluoropyrimidine.
• Mechanism: Converted enzymatically to 5-fluorouracil in the body, which inhibits thymidylate synthase, interfering with DNA production.
• Administration: Oral tablets, taken twice daily for 14 days followed by a 7-day rest period.

2. Oxaliplatin:
• Class: Platinum-based drug.
• Mechanism: Forms cross-links with DNA, leading to apoptosis.
• Administration: Intravenous infusion, typically given on the first day of the treatment cycle.

Clinical Pearls

• Neurotoxicity: Monitor for symptoms of peripheral neuropathy caused by oxaliplatin, such as tingling or numbness in the hands and feet. Symptoms can worsen with cold exposure.

• Hand-Foot Syndrome: Capecitabine can cause palmar-plantar erythrodysesthesia. Educate patients on how to manage symptoms and when to report severe cases.

• Dose Modifications: Both drugs are dosed based on body surface area and may require adjustment based on toxicity, particularly renal function for oxaliplatin and hepatic function for capecitabine.

• Dehydration Risk: Encourage adequate hydration to help manage nausea and prevent dehydration, which can exacerbate side effects.

Patient Management Tips

• Sun Protection: Advise patients to use sunscreen and wear protective clothing as capecitabine can increase photosensitivity.

• Dietary Considerations: Discuss dietary changes that might help manage nausea and avoid foods that are difficult to digest.

• Regular Monitoring: Schedule routine follow-ups to assess response to treatment, manage side effects, and adjust the treatment plan as necessary.

• Psychological Support: Provide access to counseling or support groups to help patients cope with the psychological impacts of cancer and its treatment, improving overall treatment compliance.

• Education on Drug Interactions: Capecitabine should be used cautiously with warfarin and other anticoagulants due to increased risk of bleeding. Regular monitoring of INR levels is recommended.