Is anyone on Capecitabine for pancreatic cancer?

I just finished a 28 day cycle of radiation and 1500mg of capcitabine twice per day on treatment days. This followed 12 cycles of folfurinox between June and December 2023. Side effects were minimal. My hair thinned out during the folfurinox treatment but filled in over the past month while on capcitabine. I developed neuropathy from the oxaliplatin. That has not subsided. The capcitabine does not cause neuropathy but if you already have it from the folfurinox treatment, capcitabine can exacerbate it. That’s been the case with me. Hoping for the best with treatment outcome and reduction in neuropathy. All their best to you as well.

I was wondering why the change after 12 cycles of chemo (fulfurinox) to radiation treatment. Was this a result of a CT scan or normal planned treatment?
I just completed 13 chemo treatments of Gemzar/Abraxane with declining CA-19 until the last two blood tests which indicated a leveling off at approximately 225 also a slight thickening of my pancreatic mass from the last scan. My oncologist mentioned some radiation treatment may be next with the inclusion of 500 mg of capcitabine, twice daily, during the radiation treatments. He would plan to continue the same chemo regiment following the radiation treatments.
Thank you for your post…. it has been very helpful. My very best to you.

اريد معرفة أخر علاج ناجع في القضاء على سرطان البنكرياس

Translation
I want to know the latest effective treatment for eliminating pancreatic cancer

Capecitabine is not really an oral or reduced version of "Folfirinox" proper (which is the 4-drug cocktail of "FOLinic acid" + "Flurouracil" + "IRINotecan" + "OXaliplatin"), but kind of a subset of it.

Borrowed (for conciseness) from Wikipedia https://en.wikipedia.org/wiki/FOLFIRINOX :

FOL – folinic acid (leucovorin), a vitamin B derivative that enhances the effects of 5-fluorouracil (5-FU);[1][2]

F – fluorouracil (5-FU), a pyrimidine analog and antimetabolite which incorporates into the DNA molecule and stops DNA synthesis;

IRIN – irinotecan (Camptosar), a topoisomerase inhibitor, which prevents DNA from uncoiling and duplicating;

OX – oxaliplatin (Eloxatin), a platinum-based antineoplastic agent, which inhibits DNA repair and/or DNA synthesis.

---

There was some discussion here last month: https://connect.mayoclinic.org/discussion/tumor-cant-be-removed/?pg=4#comment-986782 including some questions/thoughts from me and wise answers from @stageivsurvivor .

The three short takeaways from that discussion related to its content were:

1) https://pubmed.ncbi.nlm.nih.gov/15763604/
Capecitabine was developed as a prodrug of FU, with the goal of improving tolerability and intratumor drug concentrations through tumor-specific conversion to the active drug.

2) https://www.accessdata.fda.gov/drugsatfda_docs/label/2000/20896lbl.pdf
"[capecitabine] ... is ... an orally administered systemic prodrug of 5’-deoxy-5-fluorouridine (5’-DFUR) which is converted to 5-fluorouracil."

3) "Clinical studies have concluded 5-FU by the IV route is more beneficial (than oral) and why it is used as first -line therapy"

Sadly, I won't be spending much time on hair regrowth research until I get off the Abraxane!

Capcitabine …
I spent the first three weeks of December at Mayo receiving daily protron radiation and taking Capcitabine twice a day.

After a brutal experience with infused chemotherapy I was very hesitant to put any chemo in my body again. My oncologist asked me to try it with the promise that it would be immediately discontinued if it made me sick.
I agreed and am pleased that I did.

Other than easily managed minor nausea the second and third days I had no side effects. After the second week I actually felt physically better, more energetic.
This continued in the third week and afterwards. And through it all my hair continued to grow back.

Asking one of the Mayo docs about Capcitabine he joked that it was “chemo junior”.

The plan from the start of treatment had been 12 cycles of folfurinox followed by 28 days of chemo(capecitabine)/radiation. I had a distal pancreatectomy and splenectomy in May 2023. My CA19 was 57 prior to surgery and 15 three weeks after. It has been in the 8-11 range throughout treatment and scans have been clean. Now that I’m finished treatment it’s wait and see. Next scans and bloodwork scheduled for the first week of March. Hoping for the best. Good luck to you and everyone else on this journey we wish we didn’t have to be on.

thanks again everyone for providing so much useful information.

I've tried to do a lot of research on CA19 results. I'm not having much luck. What I want to understand is if my number is 200 , 400 or 4,000 do the numbers represent a magnitude of the cancer in my body, or how rapidly it is growing.

Most of the things I find just reference the "direction" the number is going and how that says if things are getting better or worse?

Could someone enlighten me 🙂

Thank you so much for everyone's thoughts on so many different subjects.

CA19-9 is a protein shed by some cancers. Other cancers have other protein markers (my friend gets a CA25 test). A small percentage of people (myself included) never have CA19-9 reading above average (for example: Lab range is < 3 to 32> and my highest was 20 and now is 7 or lower depending on the testing lab -- methods vary). Some CA19-9 numbers can get quite high. So if yours are showing out of range, it may be something they may or may not find valuable to monitor.

Hello Waltsocal,
I have an unknown variant on atm gene. My ca prior to removal of my stage 2 pancreatic cancer was 91, prior to 5Fu chemo it was 8, by end of 12 cycles if 5FU (June 15,2023) it was 6. In Nov 2023 it got up to 223 and in January 2024 it was 3840. I’m now receiving the gem/abraxane/cis chemo and after 3 treatments I’m down to 2120. In my case, and my current UCLA oncologist agrees, ca19-9 is a good indicator of the pancreatic cancer progression. I wish you luck in your journey.

Forgot to mention I’m Stage 4 now, so I’m my case with my genetics the ca19-9 is a good indicator, but others says with the BRCA gene, it may not be. It’s in my liver now and abdomen and hepatic artery. Have to pair that with mri and Ct. I’ve had 3 PET scans and I think they were a waste of resources.