Long-Term Safety Data on S-1 Administered After Previous Intolerance to Capecitabine-Containing Systemic Treatment for Metastatic Colorectal Cancer

Clin Colorectal Cancer. 2022 Sep;21(3):229-235. doi: 10.1016/j.clcc.2022.02.004. Epub 2022 Mar 2.


Introduction: The oral fluoropyrimidine S-1 has shown comparable efficacy to capecitabine in Asian and some Western studies on metastatic colorectal cancer. S-1 is associated with a lower incidence of hand-foot syndrome (HFS) and cardiac toxicity. We assessed the long-term tolerability of S-1 in patients who discontinued capecitabine for reasons of HFS or cardiac toxicity.

Patients and methods: Patients with metastatic colorectal cancer who switched from capecitabine to S-1, given as monotherapy or in combination with other agents, were identified in a Dutch prospective cohort study (2016-2021). The incidence and severity of HFS, cardiotoxicity and other toxicities were assessed.

Results: Forty-seven patients were identified. The median duration of capecitabine treatment was 81 days (range 4-454). In 19 patients (40%) a dose reduction was applied prior to switch to S-1. Reasons for discontinuation of capecitabine were HFS in 36 (77%) patients, coronary artery vasospasms in 10 (21%) patients, and gastrointestinal toxicities in 1 patient (2%). The median number of S-1 cycles was 6 (range 1-36). The median time between last dose of capecitabine and first dose of S-1 was 11 days (range 1-49). After switch to S-1, all patients with prior HFS developed a lower grade or complete resolution of symptoms, and in all other patients symptoms did not recur. Other S-1-related adverse events were limited to grade 1-2. Six patients (13%) discontinued S-1 due to either known fluoropyrimidine-related or bevacizumab-related toxicities. Switch to S-1 did not appear to compromise treatment efficacy.

Conclusion: S-1 is a valid alternative to capecitabine in case HFS or cardiotoxicity occurs.

Keywords: Capecitabine intolerance; Cardiotoxicity; Hand-foot syndrome.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Capecitabine
  • Cardiotoxicity / epidemiology
  • Cardiotoxicity / etiology
  • Colonic Neoplasms* / drug therapy
  • Colorectal Neoplasms* / pathology
  • Fluorouracil / adverse effects
  • Hand-Foot Syndrome* / epidemiology
  • Hand-Foot Syndrome* / etiology
  • Humans
  • Prospective Studies
  • Rectal Neoplasms* / drug therapy


  • Capecitabine
  • Fluorouracil