Improved outcomes for breast cancer patients with capecitabine

Improved outcomes for breast cancer patients with capecitabine

9 Dec 2015

Treatment with the chemotherapy agent capecitabine increased disease-free survival for women with HER2-negative breast cancer that was not eliminated by pre-surgery chemotherapy, according to results from the phase 3 CREATE-X clinical trial. The treatment given to shrink or eliminate a tumor before surgery is called neoadjuvant therapy.

In some patients with breast cancer treated with neoadjuvant chemotherapy, residual invasive cancer can be detected in breast tissue samples and lymph nodes removed during surgery. These patients tend to have worse long-term outcomes compared with women who respond completely to neoadjuvant therapy.

“It has been suggested that patients with residual invasive disease after neoadjuvant chemotherapy have chemo-resistant breast cancer, but there have been no large-scale clinical trials to test whether adjuvant systemic chemotherapy is beneficial for these patients,” said Masakazu Toi, MD, PhD, a professor at Kyoto University Hospital in Japan, and founder and senior director of the Japan Breast Cancer Research Group (JBCRG).


Disease-free survival is significantly improved

CREATE-X was designed to evaluate this clinical question by testing whether capecitabine could improve disease-free survival for patients with residual invasive disease after neoadjuvant chemotherapy. Toi and colleagues enrolled 910 patients in the trial all of whom had HER2-negative breast cancer and residual invasive disease after neoadjuvant therapy that included an anthracycline and/or a taxane.

All patients received standard treatment—hormone therapy or chemotherapy, depending on hormone-receptor status—and were randomly assigned to capecitabine or no the 455 patients randomly assigned capecitabine received eight cycles, each lasting 21 days, with 1,250 milligrams of the chemotherapeutic per meter squared twice a day for the first 14 days, followed by seven days with no treatment.

The researchers found that, two years after starting the study:

  • Patients who were assigned capecitabine had a 31% reduced risk of disease recurrence compared with those assigned placebo
  • Disease-free survival was 87.3% for those assigned capecitabine and 80.5% for those assigned placebo, a significant improvement by adding capecitabine to standard therapy.
  • There was a nonsignificant tendency to improved overall survival for those assigned capecitabine
  • Two-year median overall survival was 96.2% versus 93.9%

Manageable side effects

The side effects of the treatment were manageable and the benefit of capecitabine treatment was clear. Toi explained that these data are not yet mature and it is possible that overall survival differences will become more pronounced as more time elapses.

Toi also noted that the researchers are conducting subset analyses to determine whether certain groups of patients benefited more than others from capecitabine. For example, they are looking at whether hormone-receptor status affected outcomes, he said.

Source: eCancer News

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