Capecitabine in the treatment of esophageal and gastric cancers

Introduction: Fluoropyrimidine therapy has been a mainstay in the treatment of cancers of the esophagus and stomach for nearly half of a century in the form of intravenous 5-fluorouracil. Capecitabine, an oral fluoropyrimidine precursor, was first approved in 2001 for the treatment of metastatic colon cancer and may be used interchangeably with parenteral 5-FU in the treatment of upper gastrointestinal (GI) cancers. Areas covered: In this article, mechanisms of action and synergy with other systemic therapies and radiation are reviewed. A summary of the most important clinical trial results shaping the use of capecitabine in the treatment of cancers of the esophagus and stomach is offered, along with an update of upcoming areas of interest using this agent in these disease types. Expert opinion: Improvements in understanding molecular mechanisms of disease, defining distinct disease subtypes based on histology, genetic background and levels of protein expression as well as signaling pathways may start to clarify the reasons underlying heterogeneous clinical behaviors and different outcomes between patients with seemingly similar tumor types. Capecitabine ushered in the era of oral chemotherapy, providing ease of administration with comparable if not superior efficacy to its older parental counterpart. The best way to fully exploit its potential in gastroesophageal cancers is being actively studied worldwide at all stages of disease management.