Sie sind bereits registriert?
Loggen Sie sich mit Ihrem Universimed-Benutzerkonto ein:
Sie sind noch nicht registriert?
Registrieren Sie sich jetzt kostenlos auf universimed.com und erhalten Sie Zugang zu allen Artikeln, bewerten Sie Inhalte und speichern Sie interessante Beiträge in Ihrem persönlichen Bereich zum späteren Lesen. Ihre Registrierung ist für alle Unversimed-Portale gültig. (inkl. allgemeineplus.at & med-Diplom.at)
More to Be Gained with Capecitabine in Breast Cancer?
Optimizing adjuvant therapy to reduce risk for recurrence has been a quest for decades, particularly in patients with higher risk triple-negative breast cancer (TNBC). A recent meta-analysis demonstrated that in patients with higher risk, early-stage TNBC, the addition of pembrolizumab to neoadjuvant chemotherapy improved pathologic complete response and prolonged event-free survival (Cancer Res 2020; 80 suppl 4; abstr GS1-07). The CREATE-X trial demonstrated that the addition of postoperative capecitabine, particularly in patients with TNBC who had residual disease following neoadjuvant therapy, further reduced risk of recurrence (NEJM JW Oncol Hematol Aug 2017 and N Engl J Med 2017; 376:2147). One of the first trials to evaluate the addition of capecitabine to standard chemotherapy was the Finland Capecitabine Trial (Fin XX), and now, investigators report 15-year overall survival results.
In Fin XX, 1500 patients with axillary node–positive or high-risk, axillary node–negative breast cancer were randomized to three cycles of docetaxel followed by three cycles of cyclophosphamide, epirubicin, and fluorouracil (T-CEF) or to three cycles of docetaxel with capecitabine followed by three cycles of cyclophosphamide, epirubicin, and capecitabine (TX-CEX). In patients with ER-positive tumors, adjuvant endocrine therapy was initiated within 2 months after completion of chemotherapy. Median age was 53 years, 76% of patients were ER-positive, 19% were HER2-positive, 13% had TNBC, >90% had T1 or T2 tumors, and 89% were node positive.
Survival at 5, 10, and 15 years favored the regimen containing capecitabine; 15-year survival was 77.6% in the TX-CEX group versus 73.3% in the T-CEF group (hazard ratio, 0.81; P=0.037). Exploratory subgroup analysis suggested that patients with ER-negative disease and those with TNBC lived longer with the addition of capecitabine.
Although earlier reports from this trial suggested an improvement in survival with the addition of capecitabine, only these long-term 15-year follow-up data show a statistically significant improvement. A trial from China with similar design reported an improvement in disease-free survival with the addition of capecitabine to standard chemotherapy in a TNBC population (J Clin Oncol 2020; 38:1774). Although newer therapies such as PARP inhibitors and immunotherapy may improve outcomes in a subset of patients with TNBC, these data suggest that an old drug, capecitabine, may have a role in a larger fraction of patients with higher risk, early-stage breast cancer who are not ER-positive.
Joensuu H et al.
Title: Adjuvant capecitabine for early breast cancer: 15-year overall survival results from a randomized trial.
Source: J Clin Oncol 2022 Jan 12; [e-pub]. (Abstract/FREE Full Text)