Oxaliplatin and capecitabine (XELOX)

Oxaliplatin and capecitabine is a chemotherapy combination known as XELOX. This combination might also be called CAPOX, CAPE-OX or OxCap. 

It is a treatment for:

• bowel cancer (colorectal cancer)
• cancer of the food pipe (oesophagus)
• stomach cancer

How does oxaliplatin and capecitabine work?

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How do you have oxaliplatin and capecitabine?

You have oxaliplatin into your bloodstream (intravenously).

Capecitabine comes as tablets that you swallow whole, with plenty of water. You usually take the tablets twice a day, about 12 hours apart. You should take them within 30 minutes of finishing a meal.

Your doctor will tell you the amount (dose) of capecitabine you need to take. You might have two different strengths of tablets to make up the correct dose. 

Taking your tablets

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.

Into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

How often do you have oxaliplatin and capecitabine?

You have oxaliplatin and capecitabine chemotherapy as cycles of treatment. This means you have the drugs and then a rest to allow your body to recover.

Each cycle lasts 3 weeks (21 days). Depending on your needs, you may have between 4 and 8 cycles.

You have each treatment cycle in the following way:

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Before starting treatment with capecitabine you have a blood test to check levels of an enzyme called dihydropyrimidine dehydrogenase (DPD). A low DPD level means you are more likely to have severe side effects from these drugs. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor, pharmacist or nurse will talk to you about this.

What are the side effects of oxaliplatin and capecitabine?

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, pharmacist or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects

• your side effects aren’t getting any better

• your side effects are getting worse

• the side effects are affecting your daily life

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Numbness and tingling in the hands and feet

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your healthcare team if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums, nosebleeds, or bleeding from other areas of the body

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Less commonly you might also bleed from other areas of the body for other reasons. For instance, some people might notice their poo is quite dark or they might pass fresh blood. Rarely some people might cough up blood or have unusual bleeding from the vagina.

Let your healthcare team know straight away if you have any bleeding. 

Tiredness and weakness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Allergic reaction

A reaction may happen during the infusion, causing a skin rash, itching, swelling of the lips, face or throat, breathing diffic