Switching from Injectable to Oral Chemotherapy for Stomach Cancer: Is It Possible?

Q: Switching from Injectable to Oral Chemotherapy for Stomach Cancer: Is It Possible?

Hello： Chemotherapy for gastric cancer has a moderate emetogenic potential. <br>Generally, patients may experience some nausea after administration, but it is not usually severe or intolerable. <br>If your father's constitution is sensitive and he experiences more than just 2-3 d

Switching from injectable chemotherapy for gastric cancer to oral administration?

Hello Dr.
Chen,
My father (60 years old) underwent a partial gastrectomy due to gastric cancer.
The doctor recommended adjuvant chemotherapy (5-FU), and he has completed the eighth cycle out of twelve.
Is it possible to switch to oral chemotherapy? Before starting chemotherapy, I asked the doctor about the possibility of oral administration, but he mentioned that the oral form is less effective.
However, in the last two cycles, my father has experienced severe vomiting, and he feels a lot of psychological pressure before each treatment, often feeling fearful when going to the hospital.
Would switching to oral chemotherapy help improve this situation? Thank you.

Mr. Chen, 30~39 year old female. Ask Date: 2017/01/14

Dr. Chen Yunfang reply Oncology

Hello: Chemotherapy for gastric cancer has a moderate emetogenic potential.
Generally, patients may experience some nausea after administration, but it is not usually severe or intolerable.
If your father's constitution is sensitive and he experiences more than just 2-3 days of discomfort after each treatment, but instead has difficulty eating for over a week, you can ask the physician if they can prescribe the best antiemetic medications for him, such as Emend or Kytril.
These medications can be quite expensive, costing several hundred dollars each, and are not typically covered by insurance, but they should help him continue with chemotherapy.
If that is not feasible, the only alternative would be to switch to an oral medication regimen.
Currently, the standard is to prescribe Xeloda (which is covered by insurance), while a few patients may opt for TS-1 (which is out-of-pocket).
These options should not cause nausea.
Thank you!

Reply Date: 2017/01/14

More Info

Switching from injectable to oral chemotherapy for stomach cancer is a topic that raises many questions, particularly regarding the efficacy and side effects of different administration routes. In your father's case, he has undergone eight cycles of injectable chemotherapy (5-FU) and is experiencing severe vomiting and psychological distress associated with his treatments. This situation is understandably concerning for both him and your family.

Firstly, it is essential to understand that 5-FU (5-fluorouracil) is a common chemotherapy drug used to treat various cancers, including stomach cancer. It can be administered intravenously or orally, with the oral form often referred to as capecitabine (Xeloda). While both forms are effective, there are differences in how they are metabolized and their side effect profiles.

The injectable form of 5-FU is known to have a moderate emetogenic potential, meaning it can cause nausea and vomiting. This side effect can be particularly distressing and may lead to significant psychological stress, as you mentioned. In contrast, oral formulations like capecitabine tend to have a different side effect profile. Many patients report that oral chemotherapy is better tolerated, with fewer instances of severe nausea and vomiting. However, it is important to note that while some patients may experience fewer side effects with oral medications, others may still have adverse reactions.

Given your father's severe vomiting after his last two cycles of chemotherapy, it is crucial to address this issue with his oncologist. There are several antiemetic medications available that can help manage nausea and vomiting associated with chemotherapy. Drugs like ondansetron, granisetron, or aprepitant (Emend) can be very effective in preventing these side effects. If your father has not been prescribed these medications, it may be worthwhile to discuss this option with his healthcare provider.

Regarding the switch to oral chemotherapy, while it is possible to change from injectable to oral forms, the decision should be made collaboratively with his oncologist. The oncologist's initial concerns about the efficacy of oral chemotherapy may stem from the fact that some patients do not respond as well to oral formulations compared to intravenous ones. However, if your father's quality of life is significantly impacted by the side effects of injectable chemotherapy, it may be worth exploring the oral option.

In summary, switching from injectable to oral chemotherapy may potentially alleviate some of the side effects your father is experiencing. However, this decision should be made in consultation with his oncologist, who can assess his specific situation and determine the best course of action. Additionally, addressing the side effects with appropriate antiemetic therapy may improve his overall experience with chemotherapy, regardless of the administration route. It is essential to prioritize your father's comfort and well-being during this challenging time.

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