Metastatic hepatocellular carcinoma (HCC) is a difficult problem to treat. Nexavar has recently been FDA approved for HCC. Among other options are older drugs, such as capecitabine (Xeloda). A pilot study showed that capecitabine (1000 mg/m2 twice daily for 14 days every 21 days) achieved a response rate of 19% in patients with advanced biliary cancer . A larger review showed that at 2,000 mg/m2/d, capecitabine produced a 50% response rate and up to a 70% 1-year overall survival rate in hepatobiliary cancer patients. A phase II trial of gemcitabine and capecitabine in patients with unresectable or metastatic cholangiocarcinoma is being conducted by the Southwest Oncology Group (SWOG). The starting dose of capecitabine is 650 mg/m2 bid, which is subsequently reduced to 162 mg/m2, based on toxicity and renal function. The starting dose of gemcitabine is 1,000 mg/m2, which is reduced to 250 mg/m2. There as well trials of Xeloda with cisplatin and oxaliplatin, Avastin and other drugs. Xeloda requires more study singly or in combination.
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