Capecitabine and Oxaliplatin (XELOX) for the Treatment of Patients with Metastatic Gastric Cancer and Severe Liver Dysfunction

Abstract

Gastric cancer patients with severe liver dysfunction secondary to hepatic metastases have limited treatment options. Most cytotoxic drugs have a narrow therapeutic index. Although both capecitabine and oxaliplatin have been well tolerated as single agents for patients with severe hepatic dysfunction, the combination of these drugs has not been investigated. We report here on a case of successful treatment of a patient suffering with severe liver dysfunction and metastatic gastric cancer; the patient was treated with a combination of capecitabine and oxaliplatin (XELOX). The initial bilirubin level of the patient was 10.9 mg/dL. After two cycles of treatment, his bilirubin level decreased to 2.1 mg/dL. He has experienced an excellent radiological response and he has received six cycles of XELOX chemotherapy. XELOX chemotherapy is feasible and it can be associated with positive outcomes for the patients suffering with metastatic gastric cancer and severe liver dysfunction.

Safe use of capecitabine-cisplatin in metastatic gastric carcinoma with severe liver dysfunction: a case report from Algeria

“…Oxaliplatin is a third-generation platinum which can replace, with the same efficiency, the cisplatin in the treatment of metastatic gastric cancer. A “phase 1 study” conducted by The Organ Dysfunction Working Group of the National Cancer Institute demonstrated that oxaliplatin administrated at the standard dose of 130mg/m 2 was well tolerated for patients with all liver failure without alteration in the clearance of the platinum species from the plasma, but they did not report the rate of bilirubin in the severe liver dysfunction group ( 8 , 9 ). According to BC cancer agency, no adjustment dose is required for mild to moderate failure ( 10 , 11 ).…”

Treatment approach in patients with hyperbilirubinemia secondary to liver metastases in gastrointestinal malignancies: a case series and review of literature

“…Eighteen patients were treated with oxaliplatinbased chemotherapy regimens (with any FP; with or without moAb; no moAb: n = 11, bevacizumab: n = 3, cetuximab: n = 1, panitumumab: n = 1) [Fakih, 2004;Hwang et al 2006;Walia et al 2008;Grenader et al 2009;Mizota et al 2011;Terasawa et al 2013;Elsoueidi et al 2014;Tural et al 2014;Kasi et al 2015] with bilirubin ranged from 3.2-29.8 mg/dl at treatment start, that dropped in 14 patients by more than 50%. OS ranged from 1.5 months to 18 months.…”

“…Available data mainly confer to small case series on the use of oxaliplatin in combination with infusional 5-FU or capecitabine for either metastatic colorectal (mCRC) or gastric cancer or single agent cetuximab [Fakih, 2004;Hwang et al 2006;Walia et al 2008;Mizota et al 2011;Elsoueidi et al 2014;Tural et al 2014].…”

Cisplatin as Single-Agent Chemotherapy in Patients with Liver Dysfunction Due to Metastases

“…Surprisingly,capecitabinehasbeenreportedtobeofusein patientswithliverdysfunctionduetobreastcancer [16],even thoughitispartiallymetabolisedbytheliver.Pharmacokineticstudiesindeedindicateonlyminorretardationofexcretion of capecitabine and its metabolites in patients with mild to moderatehepaticdysfunction [17].Inapatientwithcolorectal cancer and liver dysfunction, the combination of oxaliplatin with5-FUdidresultinpartialremission [6].Acombinationof oxaliplatinandcapecitabinehasalsobeenadministeredsuccessfullyinapatientwithliverfailureduetometastaticgastriccancer [18].…”