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Capecitabine/Paclitaxel Safe and Effective as First-Line Therapy for Metastatic Breast Cancer

Capecitabine/Paclitaxel Safe and Effective as First-Line Therapy for Metastatic Breast Cancer

CHICAGO—A capecitabine (Xeloda) plus paclitaxel regimen is effective and
safe as first-line treatment of metastatic breast cancer, according to 3-year
results of a multicenter, phase II study. Toxicity was manageable, with a
relatively low incidence of grade 3/4 adverse events, including hand-foot
syndrome. The study, which is among the latest to evaluate the potential for
synergy between capecitabine and taxanes, was described by William J. Gradishar,
MD, associate professor of medicine at Northwestern University Medical School,
Chicago.

All patients in the study received paclitaxel 175 mg/m2 on day 1
of a 21-day cycle, along with capecitabine 825 mg/m2 twice daily for
the first 14 days of that cycle. That is a lower initial capecitabine dose than
the 1,250 mg/m2 dose used in a previous phase III trial of
capecitabine plus docetaxel (Taxotere) for metastatic breast cancer. That dose
was also administered twice daily, although dose reduction was allowed for
adverse events (O’Shaughnessy J, et al: J Clin Oncol 20: 2812-23, 2002).

"We started at a lower dose of capecitabine, and that actually turned out to
be a smart move, because we maintained the activity" previously demonstrated
for capecitabine/docetaxel, while potentially limiting toxicity, Dr. Gradishar
stated.

Overall Response Rate 51%

The median age of the 47 evaluable patients was 52 years (range 35 to 76
years). Most of the patients were receiving capecitabine/paclitaxel as
first-line therapy; only three patients (6%) had received a taxane or
anthracycline in the metastatic setting. The median number of treatment cycles
was seven.

The overall response rate in the capecitabine/paclitaxel trial was 51.1%.
Median time to progression was 10.5 months and median overall survival 20.6
months. The most common grade 3/4 adverse events included seven cases of
neutropenia (15%), six cases of alopecia (13%) and five cases of grade 3
hand-foot syndrome (11%).

These findings on the potential utility of a capecitabine/taxane combination
corroborate the previously cited phase III study of capecitabine/docetaxel. In
that trial, which included more than 500 women with anthracycline-pretreated
metastatic breast cancer, capecitabine plus docetaxel resulted in a
significantly improved response rate vs docetaxel alone (42% vs 30%), as well
as prolonged time to tumor progression (6.1 vs 4.2 months) and overall survival
(14.5 vs 11.5 months). Investigators said those results suggest capecitabine/docetaxel
is "an important treatment option" for women with anthracycline-pretreated
metastatic breast cancer, particularly when considering the manageable toxicity
profile. More grade 3 adverse events were seen with combination capecitabine/docetaxel
therapy (71% vs 49%) than for docetaxel alone, although grade 4 events were
somewhat more common with docetaxel (25% for the combination and 31% for
docetaxel alone).

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