CapeOX (Capecitabine and Oxaliplatin) Prescription with Premedications
The standard CapeOX regimen consists of oxaliplatin 130 mg/m² IV over 2 hours on day 1 and capecitabine 850-1000 mg/m² twice daily orally for 14 days, repeated every 3 weeks. 1, 2
Detailed Prescription
Oxaliplatin Component:
- Oxaliplatin 130 mg/m² IV infusion over 2 hours on day 1 of each 3-week cycle 1, 2
- Administer in a separate bag from any other medications 3
- Continue treatment for 3-4 months (or sooner if significant neurotoxicity ≥ grade 2 develops) 1, 2
Capecitabine Component:
- Capecitabine 850-1000 mg/m² PO twice daily for 14 days followed by 7 days rest 1, 2
- North American patients may require the lower end of the dosing range (850 mg/m²) due to greater toxicity compared to European patients 1, 2
- Dose reduction may be required for patients with diminished creatinine clearance 1
Premedications
For Oxaliplatin:
- Antiemetic prophylaxis:
- Avoid ice chips or cold beverages during infusion and for 5 days after to reduce acute neurotoxicity 3
For Capecitabine:
- No specific premedications required for capecitabine administration 4
- Take with water within 30 minutes after a meal to improve tolerability 4
Monitoring and Toxicity Management
- Perform baseline CBC, comprehensive metabolic panel, and liver function tests before each cycle 3
- Monitor for peripheral sensory neuropathy - consider dose reduction or discontinuation of oxaliplatin if grade ≥2 neuropathy develops 2, 3
- Assess for hand-foot syndrome, diarrhea, and stomatitis which are common toxicities with capecitabine 5, 6
- Delay treatment if neutrophils <1.5 × 10⁹/L or platelets <75 × 10⁹/L 3
Special Considerations
- Discontinue oxaliplatin after 3-4 months of therapy while maintaining capecitabine until disease progression 1, 2
- Oxaliplatin may be reintroduced if it was discontinued for neurotoxicity rather than disease progression 1, 2
- Monitor closely during first cycle for toxicity, especially in elderly patients, with dose adjustments as indicated 2, 6
- No isolation precautions are required for patients taking capecitabine 7
Common Pitfalls to Avoid
- Do not use PET/CT to monitor treatment response; use CT with contrast or MRI instead 1
- Avoid cold food/drinks during oxaliplatin infusion and for several days after to prevent triggering acute neuropathy 3
- Do not continue oxaliplatin beyond 3-4 months if significant neurotoxicity develops 1, 2
- Avoid combination therapy involving cytotoxics, anti-EGFRs, and anti-VEGFs unless specifically indicated 1