Grade ≥2 Toksisite Gelişmeyen Hastalarda İnfüzyonel 5-Fluorourasil ve Oral Kapesitabin Tedavilerinde Hasta Uyumunun Karşılaştırılması: Gerçek Yaşam Verileri

Öz

Amaç: Bu çalışmanın amacı, infüzyonel 5-fluorourasil veya kapesitabin uygulanan ve grade 2 veya daha yüksek yan etki yaşamayan kanser hastalarında tedaviye uyumu karşılaştırmaktır. Bu çalışma, onkoloji çalışmalarında değerlendirilen etkinlik ve toksisite profili gibi faktörlere ek olarak, uyumun da klinisyenler için hasta sonuçları açısından önemli bir husus olduğunu göstermeyi amaçlamaktadır. Yöntemler: Bu, tek merkezde yürütülen retrospektif bir kohort çalışmasıdır. Çalışmaya, 2021 ile 2025 yılları arasında Kütahya Sağlık Bilimleri Üniversitesi Evliya Çelebi Eğitim ve Araştırma Hastanesi ve Kütahya Şehir Hastanesi'nde intravenöz 5-fluorourasil veya oral kapesitabin tedavisi alan 61 kanser hastası dahil edilmiştir. Tedaviye uyum, hastaların amaçlanan kapesitabin veya 5-fluorourasil dozunu alıp almadıklarının değerlendirilmesiyle karşılaştırılmıştır. Bulgular: Çalışmamızda, kapesitabin alan 30 hastanın 14'ünün tedaviye uyumsuz olduğu, 5-fluorourasil grubundaki 31 hastanın ise 7'sinin uyumsuz olduğu tespit edilmiştir. Kapesitabin grubunda istatistiksel olarak anlamlı düzeyde bir uyumsuzluk gözlenmiştir. Sonuç: Kapesitabin etkili ve iyi tolere edilen bir tedavidir, ancak evde oral yolla alınması, hasta uyumunun son derece önemli olduğu anlamına gelmektedir. Klinisyenler, kapesitabin tedavisinin etkinliğini sağlamak için hasta uyumuna en üst düzeyde dikkat etmelidir.

Anahtar Kelimeler

• kapesitabin
• uyum
• 5-Fluorourasil

TREATMENT ADHERENCE IN PATIENTS RECEIVING INFUSIONAL 5-FLUOROURACIL OR ORAL CAPECITABINE WITHOUT GRADE ≥2 TOXICITY: A REAL-WORLD COMPARATIVE STUDY

Öz

Aims: The aim of this study was to compare treatment adherence in cancer patients who received infusional 5-fluorouracil or capecitabine and did not experience grade 2 or higher adverse events, demonstrating that, in addition to factors such as efficacy and toxicity profile evaluated in oncology studies, adherence is also an important consideration for clinicians regarding patient outcomes. Methods: This was a retrospective cohort study conducted at a single center. The study enrolled 61 cancer patients who received either intravenous 5-fluorouracil or oral capecitabine at the Kütahya Health Sciences University Evliya Çelebi Education and Research Hospital and Kütahya City Hospital between 2021 and 2025. Treatment adherence was compared by evaluating whether patients received the intended dose of capecitabine or 5-fluorouracil. Results: Our study found that 14 out of 30 patients receiving capecitabine were non-adherent to treatment, while 7 out of 31 patients in the 5-fluorouracil group were non-adherent. A statistically significant degree of non-adherence was observed in the capecitabine group. Conclusion: Capecitabine is an effective and well-tolerated treatment, but its oral administration at home means that patient adherence is of utmost importance. Clinicians must pay the highest level of attention to patient adherence to ensure the efficacy of capecitabine treatment.

Anahtar Kelimeler

• capecitabine
• adherence
• 5-Fluorouracil

Kaynakça

1. 1. Borunda AKD, Rentería AP, Guzmán RM, Román LE, Aguilar AEM, Álvarez RG, et al. Impact of maintenance therapy with fluoropyrimidines in advanced esophageal-gastric adenocarcinoma: a retrospective study in Mexican population. J Gastrointest Oncol. 2025;16(5):1812-9.
2. 2. Zhang N, Yin Y, Xu S-J, Chen W-S. 5-Fluorouracil: mechanisms of resistance and reversal strategies. Molecules. 2008;13(8):1551-69.
3. 3. Casale J, Patel P. Fluorouracil. StatPearls [Internet]: StatPearls Publishing; 2024.
4. 4. Cardoso A, Jesus Â, Barreiros L, Carvalho D, Sá MdA, Carvalho S, et al. Safeguarding Patients, Relatives, and Nurses: A Screening Approach for Detecting 5-FU Residues on Elastomeric Infusion Pumps Using HPLC-DAD. Toxics. 2025;13(5):416.
5. 5. Saif MW. Targeting cancers in the gastrointestinal tract: role of capecitabine. OncoTargets and therapy. 2009;2:29-41.
6. 6. Van Cutsem E, Twelves C, Cassidy J, Allman D, Bajetta E, Boyer M, et al. Oral capecitabine compared with intravenous fluorouracil plus leucovorin in patients with metastatic colorectal cancer: results of a large phase III study. J Clin Oncol. 2001;19(21):4097-106.
7. 7. Hoff PM, Ansari R, Batist G, Cox J, Kocha W, Kuperminc M, et al. Comparison of oral capecitabine versus intravenous fluorouracil plus leucovorin as first-line treatment in 605 patients with metastatic colorectal cancer: results of a randomized phase III study. J Clin Oncol. 2001;19(8):2282-92.
8. 8. Twelves C, Wong A, Nowacki MP, Abt M, Burris III H, Carrato A, et al. Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med. 2005;352(26):2696-704.

9. 9. Pfeiffer P, Mortensen JP, Bjerregaard B, Eckhoff L, Schønnemann K, Sandberg E, et al. Patient preference for oral or intravenous chemotherapy: a randomised cross-over trial comparing capecitabine and Nordic fluorouracil/leucovorin in patients with colorectal cancer. Eur J Cancer. 2006;42(16):2738-43.
10. 10. Greer JA, Amoyal N, Nisotel L, Fishbein JN, MacDonald J, Stagl J, et al. A systematic review of adherence to oral antineoplastic therapies. Oncologist. 2016;21(3):354-76.
11. 11. Borner M, Schöffski P, De Wit R, Caponigro F, Comella G, Sulkes A, et al. Patient preference and pharmacokinetics of oral modulated UFT versus intravenous fluorouracil and leucovorin: a randomised crossover trial in advanced colorectal cancer. Euro J Cancer. 2002;38(3):349-58.
12. 12. Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, et al. Medication compliance and persistence: terminology and definitions. Value in health. 2008;11(1):44-7.
13. 13. Partridge AH, Avorn J, Wang PS, Winer EP. Adherence to therapy with oral antineoplastic agents. Journal of the national cancer institute. 2002;94(9):652-61.
14. 14. Foulon V, Schöffski P, Wolter P. Patient adherence to oral anticancer drugs: an emerging issue in modern oncology. Acta Clin Belg. 2011;66(2):85-96.
15. 15. Lv X, Ren W, Ran S, Zhao Y, Zhang J, Chen J, et al. Trends and prescribing patterns of oral anti-neoplastic drugs: a retrospective longitudinal study. Front Public Health. 2023;11:1294126.
16. 16. Tadic D, Spasojevic IB, Tomasevic ZI, Dejanovic SD. Oral administration of antineoplastic agents: the challenges for healthcare professionals. J BUON. 2015;20(3):690-8.
17. 17. Fernandes JP, Advinha AM, Oliveira-Martins S. Pharmaceutical consultation on patients receiving oral antineoplastic agents: a systematic review. Eur J Hosp Pharm. 2025.
18. 18. Scheithauer W, McKendrick J, Begbie S, Borner M, Burns W, Burris H, et al. Oral capecitabine as an alternative to iv 5-fluorouracil-based adjuvant therapy for colon cancer: safety results of a randomized, phase III trial. Ann Oncol. 2003;14(12):1735-43.
19. 19. Cassidy J, Twelves C, Van Cutsem E, Hoff P, Bajetta E, Boyer M, et al. First-line oral capecitabine therapy in metastatic colorectal cancer: a favorable safety profile compared with intravenous5-fluorouracil/leucovorin. Ann Oncol. 2002;13(4):566-75.
20. 20. Eek D, Krohe M, Mazar I, Horsfield A, Pompilus F, Friebe R, et al. Patient-reported preferences for oral versus intravenous administration for the treatment of cancer: a review of the literature. Patient preference and adherence. 2016:1609-21.
21. 21. Weingart SN, Brown E, Bach PB, Eng K, Johnson SA, Kuzel TM, et al. NCCN task force report: oral chemotherapy. J Natl Compr Canc Netw. 2008;6(S3):S-1-S-14.
22. 22. Sabaté E. Adherence to long-term therapies: evidence for action: World Health Organization; 2003.