Capecitabina oral

Journal Scan / Review · July 24, 2020

Capecitabine for the Treatment and Prevention of Actinic Keratoses, Squamous Cell Carcinoma, and Basal Cell Carcinoma

JAMA Dermatology

TAKE-HOME MESSAGE

• This systematic review included 23 patients who received capecitabine for chemoprevention of cutaneous squamous cell carcinoma (SCC) as well as several smaller case reports and case series of patients receiving capecitabine for other cancers who experienced decreased rates of actinic keratoses, SCCs, and basal cell carcinomas. Low-dose oral capecitabine for chemoprevention typically is administered at 500 to 1000 mg twice daily during days 1 to 14 of a 21-day cycle. Of these 23 patients, 43% discontinued capecitabine due to the severity of adverse effects, whereas 30% experienced only mild or no adverse effects. Of those who tolerated capecitabine, most experienced a more than 50% reduction in SCC incidence rate.

• Patients who may benefit from low-dose capecitabine include high-risk solid-organ transplant recipients who develop more than 5 SCCs per year or develop aggressive SCCs. Further studies are needed to determine whether the benefits of capecitabine as chemoprevention outweigh the significant risk of adverse effects.

– Caitlyn T. Reed, MD

Abstract

IMPORTANCE

Certain patient groups, such as solid organ transplant recipients (SOTRs), have a significantly increased risk of developing skin cancers. The chemotherapeutic drug capecitabine has been used off label as a chemopreventive modality to suppress the development of precancerous skin lesions and squamous cell carcinomas (SCCs).

OBJECTIVE

To systematically review published studies on the use of capecitabine for the treatment and prevention of precancerous and cancerous skin lesions, with a focus on cutaneous SCC.

EVIDENCE REVIEW

For this systematic review, a literature search was performed using the PubMed and Embase databases in December 2019 for all articles published between January 1, 1998, and December 31, 2019, using the search term capecitabine paired with each of the following terms: actinic keratosis, actinic keratoses, squamous cell carcinoma, and basal cell carcinoma. Articles on the use of capecitabine for the treatment and prevention of actinic keratoses (AKs), SCCs, and basal cell carcinomas (BCCs) were selected for inclusion.

FINDINGS

Sixteen publications met the criteria for inclusion, with 8 case reports describing the inflammation of AKs in patients with solid organ cancer treated with capecitabine (2 patients with breast cancer and 6 patients with colorectal cancer). One case report and 1 case series of 4 patients investigated the use of capecitabine for the treatment of advanced or widespread cutaneous SCCs. A total of 6 publications (3 case reports and 3 case series) described the use of capecitabine to prevent development of SCCs in SOTRs. Of these case series, 2 studies found a significant reduction in SCC incidence rate during treatment with capecitabine compared with before treatment. Adverse effects, such as fatigue, nausea, vomiting, diarrhea, elevated creatinine level, hand-foot syndrome, hyperuricemia, weight loss, anemia, and cardiomyopathy, limited the duration of chemoprevention in several patients.

CONCLUSIONS AND RELEVANCE

Capecitabine treatment may be associated with a decrease in the incidence of SCCs in SOTRs. Capecitabine treatment may also be associated with a decrease in AK and BCC incidence. However, practitioners must weigh this benefit against the risk of adverse effects for each patient individually. Further investigation with a prospective clinical trial is warranted.

JAMA Dermatology

Evaluation of the Use of Capecitabine for the Treatment and Prevention of Actinic Keratoses, Squamous Cell Carcinoma, and Basal Cell Carcinoma: A Systematic Review

JAMA Dermatol 2020 Jul 08;[EPub Ahead of Print], DM Schauder, J Kim, RI Nijhawan 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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