Capecitabine ( Xeloda ) is a first-line, adjuvant, or combination treatment for colon cancer, and for metastatic colorectal cancer, gastric cancer, or breast cancer.

Skin reactions associated with the use of Capecitabine include palmar-plantar erythrodysaesthesia ( hand-foot syndrome ) and dermatitis, which occur very commonly ( ie, greater than 10% of patients ).
Rash, alopecia, erythema, and dry skin are common reactions. Furthermore, pruritus, localised exfoliation, skin hyperpigmentation, photosensitivity reactions, and radiation recall syndromes ( severe skin reactions that can occur when chemotherapy agents are administered after radiotherapy ) have also been seen with Capecitabine.

Severe skin reactions such as Stevens-Johnson syndrome ( SJS ) and toxic epidermal necrolysis ( TEN ) have been reported very rarely ( ie, fewer than one in 10 000 ).
Between 2002 and December 2013, 20 cases of suspected Stevens-Johnson syndrome or toxic epidermal necrolysis have been reported in the UK, six of which were taking other medicines considered to be cosuspect for these reactions.

Advice for healthcare professionals

Toxic epidermal necrolysis and Stevens-Johnson syndrome are characterised by generalised tender erythematous maculae, progressing to blisters and denudation and commonly preceded by photophobia, symptoms of upper respiratory tract infection, and fever.

Patients should be informed of the possibility of such reactions and informed to seek urgent medical advice should any symptoms of a severe skin reaction occur.

Capecitabine should be permanently discontinued in patients who have a severe skin reaction during treatment; the reaction should be treated promptly. ( Xagena )

MHRA: Drug Safety Update volume 7 issue 6, 2014: A4

XagenaMedicine2014