Original Article

Efficacy of Lower Dose Capecitabine in Patients with Metastatic Breast Cancer and Factors Influencing Therapeutic Response and Outcome

Authors: Canfeza Sezgin, MD, Ender Kurt, Turkan Evrensel, Necmettin Ozdemir, Osman Manavoglu, Erdem Goker

Abstract

Objective: Capecitabine exerts considerable therapeutic efficacy in metastatic breast cancer (MBC) patients previously treated with anthracyclines and taxanes.


Materials and Methods: In this study, the efficacy and safety of lower dose capecitabine (2000 mg/m2/d) in patients with anthracycline- and taxane-pretreated MBC were studied with a special emphasis on the potential predictors of time to tumor progression (TTP) and response to the capecitabine treatment.


Results: The overall response rate (ORR) was 17%. The median TTP was 5 months. Among various factors analyzed, univariate analysis showed that a performance status (PS) of 2 and the presence of visceral metastases were inversely correlated with TTP. Multivariate analysis showed that a poor PS score was associated with impaired TTP.


Conclusions: Our study indicates that lower dose capecitabine has substantial antitumor activity and a favorable safety profile in the treatment of anthracycline- and taxane-pretreated MBC. Also, only performance score was demonstrated to be a significant parameter affecting TTP.


Key Points


* The therapy of metastatic breast cancer is palliative and systemic treatment options mainly consist of chemotherapy, hormonal therapy, as well as the targeted therapies.


* Capecitabine is active against anthracycline- and taxane-pretreated metastatic breast cancer. The use of capecitabine at the FDA-approved dose (2500 mg/m2/day) leads to unacceptable toxicity in many patients. Anecdotal reports have suggested that dose reductions improve tolerability without compromising efficacy.


* Factors influencing therapeutic response to capecitabine have not been clearly demonstrated.


* Our study showed that a lower starting dose (2000 mg/m2/day) of capecitabine improves tolerability without compromising efficacy in pretreated metastatic breast cancer. However, a phase III, randomized, multicenter study to establish the safety and efficacy of different doses of capecitabine is needed.

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