Capecitabine and Gemcitabine in Patients With Metastatic Colorectal Cancer

Inclusion Criteria: Histologically confirmed metastatic adenocarcinoma of the colon or rectum, with measurable disease. The primary histologic diagnosis is sufficient if there is clear evidence by imaging and/or markers of metastatic disease sites. Patients must have failed CPT-11 and oxaliplatin based therapies. Patients must have received at least two prior chemotherapy regimens for advanced disease (completed > 4 weeks prior to enrollment). Tumor must be accessible for biopsy or paraffin embedded tissue must be available for review. SWOG performance status 0-2. AGC >1000, platelets >100,000. Total bilirubin < 3 x upper limit of normal. Transaminase (AST and/or ALT) < 2 x upper limit of normal or < 5 x upper limit of normal in patients with liver metastasis. Patients must have a measured or calculated creatinine clearance greater than 35 mL/min obtained within 28 days prior to registration. Age greater than or equal to 18 years Patients should have hemoglobin > 9 g/dL; patients may be transfused to achieve this level of hemoglobin. Except for cancer-related abnormalities, patients should not have unstable or pre-existing major medical conditions. Exclusion Criteria: History of a malignancy other than colon or rectal cancer, except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or other cancer for which the patient has been disease-free for five years. Patients with brain metastasis. History of recent (within one year) myocardial infarction or evidence of congestive heart failure. Patients that have psychological, familial, sociological, or geographical conditions that do not permit medical follow-up and compliance with the study protocol. Patients should not have any immediate life-threatening complications of their malignancies.