XELOX Treatment
This handout gives general information about this cancer treatment.
You will learn:
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who to contact for help
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what the treatment is
-
how it is given
-
what to expect while on treatment
This handout was created by Ontario Health (Cancer Care Ontario) together with patients and their caregivers who have also gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.
This information does not replace the advice of your health care team. Always talk to your health care team about your treatment.
My cancer health care provider is: _____________________________________________
During the day I should contact: _______________________________________________
Evenings, weekends and holidays: _____________________________________________
This page gives general information about this cancer treatment.
You will learn:
-
who to contact for help
-
what the treatment is
-
how it is given
-
what to expect while on treatment
This information was created by Ontario Health (Cancer Care Ontario) together with patients and their caregivers who have also gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.
This information does not replace the advice of your health care team. Always talk to your health care team about your treatment.
XELOX is the code name of your cancer treatment regimen.
A regimen is a combination of medications to treat cancer.
This regimen name is made up of one or more letters from the names of the 2 medications in your treatment.
Here are the names of the medications in this regimen:
XEL = Capecitabine (also known as XELoda®)
OX = OXaliplatin
Treatment is divided into cycles. Each cycle is 3 weeks long. Your health care team will tell you how many cycles you need.
Here is a picture of the schedule for XELOX treatment:
Cycle 1 XELOX (3 weeks)
Repeat XELOX (3 weeks)
Your health care team will tell you how many cycles you will have.
During each 3 week cycle you will have oxaliplatin treatment on day 1 at the hospital. You will also take capecitabine tablets on day 1 and continue these at home for 14 days. (2 weeks on, 1 week off).
Each cycle looks like this:
Day 1
Hospital treatment day:
Go to the hospital for oxaliplatin treatment.
Take your capecitabine (morning and evening).
2
Take your capecitabine (morning and evening)
3
Take your capecitabine (morning and evening)
4
Take your capecitabine (morning and evening)
5
Take your capecitabine (morning and evening)
6
Take your capecitabine (morning and evening)
7
Take your capecitabine (morning and evening)
8
Take your capecitabine (morning and evening)
9
Take your capecitabine (morning and evening)
10
Take your capecitabine (morning and evening)
11
Take your capecitabine (morning and evening)
12
Take your capecitabine (morning and evening)
13
Take your capecitabine (morning and evening)
14
Take your capecitabine (morning and evening)
15
NO XELOX Treatment
16
17
18
19
20
21
Remember To:
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Tell your health care team about all of the other medications you are taking.
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Keep taking other medications that have been prescribed for you, unless you have been told not to by your health care team.
You will have a blood test to check for hepatitis B before starting treatment. See the Hepatitis B and Cancer Medications pamphlet for more information.
Your health care team may ask you to have a blood test to check for DPD deficiency before starting treatment.
- DPD deficiency is when you have low or no activity of an enzyme called DPD (dihydropyrimidine dehydrogenase). A deficiency can cause you to have severe side effects from capecitabine.
- See the Testing for people taking capecitabine or 5-fluorouracil (5-FU) pamphlet for more information.
Oxaliplatin is given through an IV (injected into a vein) at the hospital.
Capecitabine is given as tablets that you swallow.
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Your health care team will tell you how many capecitabine tablets you need to take.
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Do not take your medicine more often or for longer than you have been told to.
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You may need tablets of different strengths to get the right dose. Make sure you look at the tablets closely so that you take the right dose.
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Take capecitabine two times each day. Space each dose about 12 hours apart.
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Swallow the tablets whole with a full glass of water. Take with food, up to 30 minutes after eating a meal (for example, right after breakfast and dinner).
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Do not crush or chew the capecitabine tablets.
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If you forget to take a dose, do not take an extra dose to make up for the missed dose. Follow the instructions given to you or talk to your health care team if you are unsure about what to do. If you are unable to talk to your healthcare team, take your next dose at the usual time.
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If you vomit (throw up) after taking your medication, do not take another dose until you have talked to your health care team. If you are unable to talk to your health care team, take your next dose at the usual time.
You will have a blood test before each treatment cycle to make sure it is safe for you to get treatment.
Warning: If you take too much capecitabine by accident, or if you think a child or a pet may have swallowed your capecitabine, you must call the Ontario Poison Control Center right away at: 1-800-268-9017.
To Prevent Nausea and Vomiting
You will be given medications to help prevent nausea (feeling like throwing up) and vomiting (throwing up) before they start.
- These are called anti-nausea medications and include medications such as ondansetron (Zofran®), granisetron (Kytril®), dexamethasone or others.
To Treat Diarrhea
The capecitabine in your treatment regimen can cause diarrhea. Diarrhea is when you have loose bowel movements (watery poo) or you need to go poo (have bowel movements) more often than usual. Diarrhea may start a few days after your treatment.
You will be given a medication called loperamide (Imodium®) to help treat your diarrhea. Take this medication only if you need it.
Keep your loperamide with you all the time. When diarrhea starts, take the loperamide right away.
If you start to have diarrhea:
- Take 2 tablets (4mg) of loperamide right away.
- Take 1 tablet after each loose bowel movement (watery poo).
- Do not take more than 8 tablets every day.
This treatment causes cold sensitivity.
One of the medications in your treatment (oxaliplatin) can cause an unusual side effect where different parts of your body may become very sensitive to cold. This can cause discomfort from things such as cold food, cold drinks and cool or cold temperatures.
How does the cold sensitivity feel?
You may feel:
- Numbness or tingling in your fingers and toes. Sometimes it can be painful and feel like burning, which may be severe.
- Tightness in your throat or jaw
- Like it is hard to swallow
- Like it is hard to breathe, or that you have pressure on your chest
Tightness in your throat will usually go away after a few hours. If it lasts longer, or if you have trouble breathing, contact your health care team or get emergency help right away.
How can I help prevent sensitivity to cold?
- Avoid the cold as much as possible.
- If you must go outside in the cold, protect your face and mouth with a scarf or high-neck sweater, wear mittens and warm socks.
- Only eat and drink things that are room temperature or warmer. Do not drink cold drinks or put ice cubes in anything you drink. Do not eat cold foods, such as ice cream.
- Avoid direct exposure to air conditioning, such as in your car.
- Take shallow breaths when you are exposed to cold air (such as from a freezer or when you are outside in winter).
- Wear gloves if you need to touch cold objects, such as items in the freezer.
- Do not use an ice pack on any part of your body.
This treatment may cause Hand-Foot Syndrome
Hand-foot syndrome is a side-effect of capecitabine treatment that affects the skin on your hands and the bottoms of your feet. It usually starts with tingling or swelling of your skin. Your skin can become painful, red and numb. In worse cases, your skin may start to peel and you can get blisters or sores. This may start days or weeks after your treatment begins.
You can help to prevent symptoms of hand-foot syndrome by doing these things:
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Keep your skin moist, especially in the skin folds.
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Gently apply moisturizer cream or lotion to the inside of your hands and bottom of your feet as needed. Choose a fragrance-free cream that contains lanolin (like Bag Balm®, Udderly Smooth®) or urea 10% (like Uremol 10®).
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Do not let your hands and feet get too hot. Wash sweat from your skin. Bathe or shower in lukewarm water and gently pat yourself dry.
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Do not do activities that cause rubbing or pressure on your skin, like heavy-duty washing, gripping tools, typing, playing musical instruments, and driving.
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Wear gloves while cleaning to protect your skin from things like laundry detergent, bleach, cleaning products, and dish soap.
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Wear loose fitting clothes and loose fitting, comfortable shoes with cushioned soles. Do not walk in bare feet.
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Drink 6–8 glasses of liquids each day unless your health care team told you otherwise.
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DO tell your health care team about any other medical conditions that you have such as problems with nerves in hands and feet (numbness or tingling), heart, liver, lung or kidney problems, if you have or had personal or family history of severe side effects with other drugs (especially a drug called fluorouracil), any allergies or intolerances.
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DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
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DO talk to your health care team about your risk of getting other cancers and heart problems with this treatment.
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DO consider asking someone to drive you to and from the hospital on your treatment days. You may feel drowsy or dizzy after your treatment.
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DO NOT take any other medications, such as vitamins, over-the-counter (non-prescription) drugs, or natural health products without checking with your health care team.
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DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic medications, without checking with your health care team.
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DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.
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DO tell your health care team about any other medical conditions that you have such as problems with nerves in hands and feet (numbness or tingling), heart, liver, lung or kidney problems, if you have or had personal or family history of severe side effects with other drugs (especially a drug called fluorouracil), any allergies or intolerances.
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DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
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DO talk to your health care team about your risk of getting other cancers and heart problems with this treatment.
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DO consider asking someone to drive you to and from the hospital on your treatment days. You may feel drowsy or dizzy after your treatment.
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DO NOT take any other medications, such as vitamins, over-the-counter (non-prescription) drugs, or natural health products without checking with your health care team.
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DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic medications, without checking with your health care team.
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DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.
Yes, the medications in this regimen can interact with other medications, vitamins, foods and natural health products. Interactions can make the treatment not work as well or cause severe side effects.
Tell your health care team about all of your:
- prescription and over-the-counter (non-prescription) medications
- natural health products such as vitamins, herbal teas, homeopathic medicines, and other supplements
Check with your health care team before starting or stopping any of them.
If you take seizure medications (such as phenytoin), your health care team may monitor your blood levels closely and may change your dose.
If you are taking a blood thinner (such as warfarin), your health care team may need extra blood tests and may change your dose.
- Anti-inflammatory medications such as ibuprofen (Advil® or Motrin®), naproxen (Aleve®) or Aspirin®.
- Over-the-counter products such as dimenhydrinate (Gravol®)
- Natural health products such as St. John’s Wort
- Supplements such as vitamin C
- Grapefruit juice
- Alcoholic drinks
- Tobacco
- All other drugs, such as marijuana or cannabis (medical or recreational)
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Always check your temperature to see if you have a fever before taking any medications for fever or pain (such as acetaminophen (Tylenol®) or ibuprofen (Advil®)).
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Fever can be a sign of infection that may need treatment right away.
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If you take these medications before you check for fever, they may lower your temperature and you may not know you have an infection.
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How to check for fever:
Keep a digital (electronic) thermometer at home and take your temperature if you feel hot or unwell (for example, chills, headache, mild pain).
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You have a fever if your temperature taken in your mouth (oral temperature) is:
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38.3°C (100.9°F) or higher at any time
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OR
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38.0°C (100.4°F) or higher for at least one hour.
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If you do have a fever:
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Try to contact your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
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Ask your health care team for the Fever pamphlet for more information.
If you do not have a fever but have mild symptoms such as headache or mild pain:
- Ask your health care team about the right medication for you. Acetaminophen (Tylenol®) is a safe choice for most people.
Talk to your health care team before you start taking ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or ASA (Aspirin®), as they may increase your chance of bleeding or interact with your cancer treatment.
Talk to your health care team if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.
Talk to your health care team about:
- How this treatment may affect your sexual health.
- How this treatment may affect your ability to have a baby, if this applies to you.
This treatment may harm an unborn baby. Tell your health care team if you or your partner are pregnant, become pregnant during treatment, or are breastfeeding.
- If there is any chance of pregnancy happening, you and your partner together must use 2 effective forms of birth control at the same time while you are on treatment. Talk to your health care team about which birth control options are best for you, and how long you should use them after your last treatment dose.
- Do not breastfeed while on this treatment. Talk to your health care team about how long to wait before you start breastfeeding after your last treatment dose, if this applies to you.
Oxaliplatin is given and stored at the hospital.
Capecitabine:
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Keep capecitabine tablets in the original packaging at room temperature in a dry place, away from heat and light.
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Keep out of sight and reach of children and pets.
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Do not throw out any unused capecitabine tablets at home. Bring them to your pharmacy to be thrown away safely.
If you are a patient:
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Wash your hands before and after touching capecitabine.
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Swallow each pill whole. Do not crush or chew your pills.
If you are a caregiver:
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Wear nitrile or latex gloves when touching capecitabine tablets.
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Wash your hands before putting on your gloves and after taking them off, even if your skin did not touch the pills.
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Throw out your gloves after each use. Do not re-use gloves.
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Do not touch capecitabine if you are pregnant or breastfeeding.
If medication gets on your skin:
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Wash your skin with a lot of soap and water.
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If your skin gets red or irritated, talk to your health care team.
If medication gets in your eyes:
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Rinse your eyes with running water right away. Keep water flowing over your open eyes for at least 15 minutes.
The following table lists side effects that you may have when getting XELOX treatment. The table is set up to list the most common side effects first and the least common last. It is unlikely that you will have all of the side effects listed and you may have some that are not listed.
Read over the side effect table so that you know what to look for and when to get help. Keep this paper during your treatment so that you can refer to it if you need to.
Very Common Side Effects (50 or more out of 100 people) | |
Side effects and what to do | When to contact health care team |
Neuropathy (Tingling, numb toes or fingers) (May be severe) What to look for?
What to do?
In rare cases, numbness and tingling may continue long after treatment ends. If you continue to have bothersome symptoms, talk to your health care team for advice. |
Talk to your health care team, especially if you have trouble doing tasks like doing up buttons, writing, moving, or if you have severe pain or numbness |
Low neutrophils (white blood cells) in the blood (neutropenia) (May be severe) When neutrophils are low, you are at risk of getting an infection more easily. Ask your health care team for the Neutropenia (Low white blood cell count) pamphlet for more information. What to look for?
You have a fever if your temperature taken in your mouth (oral temperature) is:
What to do? If your health care team has told you that you have low neutrophils:
If you have a fever: If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you must get emergency medical help right away.
|
If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you MUST get emergency medical help right away. |
Low platelets in the blood When your platelets are low, you are at risk for bleeding and bruising. Ask your health care team for the Low Platelet Count pamphlet for more information. What to look for?
What to do? If your health care team has told you that you have low platelets:
If you have signs of bleeding:
If you have bleeding that does not stop or is severe (very heavy), you must get emergency medical help right away.
|
Talk to your health care team if you have any signs of bleeding. If you have bleeding that doesn’t stop or is severe (very heavy), you MUST get emergency medical help right away. |
Nausea and vomiting What to look for?
What to do? To help prevent nausea:
|
Talk to your healthcare team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours or if it is severe |
Rash on your hands and feet (hand-foot syndrome) (May be severe) What to look for?
What to do? To help prevent Hand-foot syndrome:
Ask your health care team for the Hand-foot syndrome pamphlet for more information. |
Talk to your health care team if it does not improve or if it is severe |
Liver problems Your health care team may check your liver function with a blood test. Liver changes do not usually cause any symptoms.
If you have any symptoms of liver problems, get emergency medical help right away. |
Get emergency medical help right away |
Diarrhea (May be severe) What to look for?
What to do? If you have diarrhea:
|
Talk to your health care team if no improvement after 24 hours of taking diarrhea medication or if severe (more than 7 times in one day) |
Common Side Effects (25 to 49 out of 100 people) | |
Side effects and what to do | When to contact health care team |
Fatigue What to look for?
What to do?
Ask your health care team for the Fatigue pamphlet for more information. |
Talk to your health care team if it does not improve or if it is severe |
Mouth sores What to look for?
To help prevent mouth sores:
If you have mouth sores:
Ask your health care team for the Oral Care (Mouth Care) pamphlet for more information. |
Talk to your health care team as soon as you notice mouth or lip sores or if it hurts to eat, drink or swallow |
Sensation that you are not breathing properly (With oxaliplatin) This can be caused by drinking cold fluids or inhaling cold air. What to look for?
What to do?
Problems with breathing and swallowing can be unpleasant. They should only last a few minutes. If they do not go away quickly or if you also feel chest pain, speak with your health care team as soon as possible. If severe, get emergency medical help right away. |
Talk to your health care team if it does not improve. Get emergency medical help right away if it is severe. |
Hair thinning or loss (Generally mild) What to look for?
What to do?
|
Talk to your health care team if this bothers you |
Less Common Side Effects (10 to 24 out of 100 people) | |
Side effects and what to do | When to contact health care team |
Constipation What to look for?
What to do? To help prevent constipation:
To help treat constipation:
Ask your health care team for the Constipation Pamphlet for more information. |
Talk to your health care team if it does not improve or if it is severe |
Mild swelling What to look for?
What to do?
If you have swelling:
|
Talk to your health care team if it does not improve or if it is severe |
Rash; dry, itchy skin What to look for?
What to do? To prevent and treat dry skin:
Rash may be severe in some rare cases and cause your skin to blister or peel. If this happens, get emergency medical help right away. |
Talk to your health care team if it does not improve or if it is severe |
Mild joint, muscle pain or cramps What to look for?
What to do?
Ask your health care team for the Pain pamphlet for more information. |
Talk to your health care team if it does not improve or if it is severe |
Taste changes What to look for?
What to do?
|
Talk to your health care team if it does not improve or if it is severe |
Allergic reaction (With oxaliplatin) What to look for?
|
Get emergency medical help right away for severe symptoms |
Other rare, but serious side effects are possible with this treatment.
If you have any of the following, talk to your cancer health care team or get emergency medical help right away:
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Irregular heartbeat, shortness of breath, chest pain, fainting spells
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Swelling in your ankles and belly
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Pain, swelling and hardening of a vein in an arm or leg
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New cough or coughing up blood
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Feeling confused, having trouble with speaking, moving your arms or legs, problems with balancing yourself, or trouble with eye or face movements
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Seizures
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Any sudden changes to your vision (eye sight)
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Leg weakness that may spread to the upper body
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Severe belly pain, bloating or feeling of fullness and severe constipation
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Lower back pain, swelling, peeing less than usual, or new unexpected weight gain
For more information on how to manage your symptoms ask your health care provider, or visit: https://www.cancercareontario.ca/symptoms.
October 2023 Updated " How will this medication affect sex, pregnancy and breastfeeding" section
For more links on how to manage your symptoms go to www.cancercareontario.ca/symptoms.
The information set out in the medication information sheets, regimen information sheets, and symptom management information(for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.
A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.