How do you best incorporate use of filgrastim/pegfilgrastim in capecitabine based regimens?

Neutropenia during capecitabine is almost always a dose-related issue. Neutropenia can be thought of as a pharmacodynamic marker of drug exposure. If a patient is experiencing dose-limiting neutropenia during capecitabine-based therapy, they are likely receiving an excessive dose of one of the chemo...

Since you can’t use G-CSF or similar agents while on chemo, the long duration of capecitabine regimens such as cape/ox functionally prohibits its use. Instead, I would favor dose reduction as the best strategy to improve neutropenia.

Capecitabine is a novel fluoropyrimidine carbamate, a prodrug of 5-fluorouracil, that is rationally designed to generate 5-fluorouracil (5-FU) preferentially in tumor tissue. After oral intake, capecitabine is converted to 5-fluorouracil through a 3-step enzymatic process. It is first metabolized in...