Capecitabine was designed to convert to active 5-fluorouracil preferentially inside tumour tissue, because tumours tend to carry higher levels of the enzyme that triggers the final conversion step.
CAPOX and XELOX — The Tablet-Based Alternative to a Pump
If your chart shows CAPOX or XELOX, both names refer to the same two-drug combination. Capecitabine tablets replace the continuous pump that older regimens use, and oxaliplatin is given as a short infusion in the day-care unit.
- Two names, one regimen — CAPOX and XELOX are different abbreviations for the same drugs: capecitabine and oxaliplatin.
- Tablet plus infusion — Oxaliplatin is given in the day-care unit. Capecitabine is taken as a tablet at home for the following days.
- No continuous pump — Capecitabine replaces the 46-hour intravenous 5-FU pump used in regimens such as FOLFOX.
- Used in colorectal and other cancers — CAPOX is used after surgery for colorectal cancer and in some stomach and gastroesophageal cancers.
Medically reviewed by Dr. T. Raghavender Reddy, Medical Oncologist, MBBS · DM (Medical Oncology) · MD (Radiation Oncology) · Last reviewed September 2026
CAPOX and XELOX are two names for exactly the same regimen. It pairs capecitabine — a tablet that your body converts to 5-fluorouracil — with oxaliplatin, given by a short infusion. Taking capecitabine as a tablet removes the need for the continuous pump and central line that intravenous 5-FU regimens require.
Are CAPOX and XELOX the same thing?
Yes — they are the same regimen. XELOX is the older name, combining Xeloda (the brand name for capecitabine) with oxaliplatin. CAPOX — from capecitabine and oxaliplatin — is now the term used in NCCN and ESMO guidelines. Either name on your chart means exactly the same two drugs.
Capecitabine is taken as tablets at home, typically for a set number of days each cycle. Oxaliplatin is given as an infusion in the day-care unit on the first day of each cycle.
Cycles follow a three-week schedule. The number your oncologist plans depends on whether treatment is being given after surgery, before surgery, or for cancer that has spread.
What to know before your first cycle
- Bring someone with you on infusion day — oxaliplatin takes a few hours and you may feel cold sensitivity before you leave.
- Avoid cold food, drinks and surfaces for several days after each infusion — oxaliplatin causes tingling in the hands, mouth and throat when you contact anything cold.
- Take capecitabine tablets within 30 minutes of a meal to reduce stomach irritation.
- Check your palms and soles each day — redness, soreness or peeling is a side effect to report before it worsens.
- Tell your team about every medicine you are taking, including Ayurvedic and herbal products, before treatment begins.
- Keep all blood test appointments — your team monitors kidney function, blood counts and liver markers throughout treatment.
What the terms on your chart mean
- CAPOX / XELOX
- Two names for the same regimen — capecitabine plus oxaliplatin. Both refer to identical treatment.
- Capecitabine
- A chemotherapy tablet. Your body converts it to 5-fluorouracil (5-FU) mainly within tumour tissue.
- Oxaliplatin
- A platinum-based chemotherapy drug given as an intravenous infusion on the first day of each cycle.
- Prodrug
- A medicine taken in an inactive form that converts to its active form inside the body. Capecitabine is a prodrug of 5-FU.
- Adjuvant
- Treatment given after surgery to reduce the chance of the cancer returning.
- Cycle
- One round of treatment followed by a rest period. CAPOX typically uses a 21-day cycle.
Who is CAPOX not suitable for?
CAPOX is not appropriate for everyone. Eligibility is decided by an oncologist based on the individual's full clinical picture, not on the diagnosis alone.
This regimen is not used, or is used only after careful individual assessment, in people who have:
- Severe kidney impairment — capecitabine is cleared by the kidneys, and inadequate function can lead to serious accumulation and toxicity
- A known complete deficiency of the enzyme DPD (dihydropyrimidine dehydrogenase) — capecitabine cannot be safely metabolised without this enzyme; partial deficiency requires specialist review before any decision is made
- Severe liver impairment
- Known hypersensitivity to platinum compounds, which includes oxaliplatin
- Pregnancy — both drugs carry significant risks to a developing foetus
People who are breastfeeding, or who have significant cardiac conditions, require individual assessment before this regimen is considered.
Why your oncologist may choose tablets over a pump
The alternative to capecitabine in colorectal regimens is intravenous 5-fluorouracil, infused continuously over about 46 hours through a portable pump attached to a central line or port. That requires a surgical procedure to place the port, regular port care, and a return visit to disconnect the pump after each cycle.
Capecitabine removes most of that. You receive the oxaliplatin infusion in day care and take your tablets at home. There is no pump to carry between visits.
Whether capecitabine is suitable for you depends on your kidney function, your ability to manage a tablet schedule reliably, and other factors your oncologist will assess individually.
Side effects and what to report
Cold sensitivity (oxaliplatin)
Oxaliplatin causes an uncomfortable tingling in the hands, mouth and throat when you touch cold surfaces or drink cold liquids. It usually appears within hours of infusion and eases between cycles. Avoid cold food, drinks and water for several days after each infusion. If the tingling persists between cycles, or you notice lasting numbness or weakness in your fingers, tell your oncologist at your next visit or sooner.
Hand-foot syndrome (capecitabine)
Redness, soreness, tingling or peeling of the palms and soles is called palmar-plantar erythrodysesthesia, or hand-foot syndrome. Moisturise the affected areas regularly and avoid tight shoes and prolonged friction. If the skin blisters, cracks or walking becomes painful, call your team the same day. Do not adjust your tablet dose yourself.
Nausea and appetite loss
Nausea is most common in the days after oxaliplatin infusion and can continue during the capecitabine tablet days. Your team will prescribe anti-nausea medicine alongside treatment — take it as directed even when you feel well, as it works best taken before nausea starts. If you cannot keep fluids down for more than 24 hours, contact your team that day.
Loose motions
Diarrhoea can occur with both drugs. Do not take over-the-counter anti-diarrhoeal medicines without asking your team first — they can mask worsening that your team needs to assess. Contact your team the same day if loose motions are clearly more frequent than your usual pattern, if there is blood or mucus, or if you are unable to drink enough to stay hydrated.
Longer-lasting nerve symptoms
Cumulative oxaliplatin exposure can cause persistent numbness or tingling in the hands and feet that is distinct from the acute cold sensitivity and may outlast treatment. Tell your oncologist if you notice lasting numbness, weakness, or difficulty with fine tasks such as holding a cup or fastening buttons — these symptoms are monitored across cycles.
Did you know?
This is why a tablet can achieve an effect that once required a continuous intravenous infusion running for nearly two days.
Source: ESMO Clinical Practice Guidelines — Colorectal Cancer
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The Infusion Day
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Frequently asked questions
Is CAPOX exactly the same as XELOX?
Yes — identical drugs, identical schedule. XELOX became the original abbreviation because Xeloda is the brand name under which capecitabine was first marketed. As generic capecitabine became standard, CAPOX — from capecitabine and oxaliplatin — became preferred in published guidelines. NCCN and ESMO now use CAPOX. Either name on your chart means the same treatment.
Why is the tablet called capecitabine and not 5-FU?
Capecitabine is a prodrug — inactive when swallowed, it converts to active 5-fluorouracil through several steps inside the body. The final conversion happens preferentially in tumour tissue, because cancer cells tend to carry higher levels of the enzyme that triggers it. The practical effect is similar to continuous 5-FU infusion, but delivered by tablet rather than pump. Your team may use the two names interchangeably in conversation, which is why the distinction matters.
Do I need a port or central line for CAPOX?
Oxaliplatin requires intravenous access on each infusion day. Whether that means a surgically placed port or a peripheral vein in the arm depends on your vein access and your team's assessment before your first cycle. What CAPOX removes, compared with FOLFOX, is the pump that runs for about 46 hours after the infusion. You leave the unit when oxaliplatin is complete and take capecitabine tablets at home.
Why does oxaliplatin cause cold sensitivity?
Oxaliplatin affects nerve endings in a way that makes them abnormally reactive to cold — touching cold surfaces or drinking cold liquids triggers the tingling. The exact mechanism is still being studied. This acute sensitivity typically eases in the days between cycles. The cumulative numbness that can develop over multiple infusions is a different effect and is monitored separately by your oncologist.
How many cycles of CAPOX will I have?
The number depends on why treatment is being given. In the adjuvant setting — after surgery — NCCN and ESMO guidelines describe typical ranges, and your oncologist will tell you what applies to your situation. For advanced disease, the plan is reviewed across cycles based on how you are responding and tolerating treatment. The number may change — cycles are described as a plan, not a fixed promise.
Is CAPOX used for cancers other than colorectal cancer?
Yes. CAPOX is used in some gastric (stomach) and gastroesophageal junction cancers, and may be appropriate in other settings depending on tumour type and current guidelines. It is most established in colorectal cancer, where both adjuvant and metastatic uses are well described in guidance from NCCN, ESMO and ASCO. Whether it applies to your specific cancer is a decision your oncologist makes based on tumour biology, stage and your individual fitness.
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