Capecitabine Impact on QOL Significant in Patients With Metastatic Breast Cancer

JAU SAO PAULO, Brazil- "Capecitabine (Xeloda) confers extensive quality of life [QOL] benefits with significant and substantial im- provement of almost all functional and symptomatic measures in patients with metastatic breast cancer [MBC]," reported Jose G. M. Segalla, MD, a medical oncologist at Fundacão Amaral Carvalho, Jau Sao Paulo, Brazil (abstract 8130). In a multicenter study, he and colleagues from other hospitals and cancer centers in Brazil monitored QOL in more than 600 MBC patients treated with oral capecitabine(Drug information on capecitabine). "Capecitabine has proven efficacy and favorable safety as monotherapy in MBC and improves survival when added to docetaxel(Drug information on docetaxel) [Taxotere] in firstline therapy," Dr. Segalla said. "However, clinical outcomes need to be balanced with patient QOL. Patient preference for oral therapy is well documented. QOL data add to understanding the potential benefits of capecitabine." For the study, 611 patients with MBC were treated with oral capecitabine (1,250 mg/m² twice daily on days 1-14 every 3 weeks). All patients had previous treatment with anthracyclines, and some had prior treatment with taxanes. QOL was evaluated at baseline, before cycle 1 of capecitabine, at weeks 7 and 13, and at treatment end using two EORTC (European Organisation for Research and Treatment of Cancer) questionnaires, QLQ-C30 (v3.0) and QLQ-BR23. The proportion of patients with improvement, stabilization, or worsening of QOL scores was determined from week 7. Improvement was defined as a 10- point or greater improvement in functional scores or symptom scores on one or more visits. Worsening QOL was defined as a 10-point or greater decrease in functional scores or a 10-point increase in symptom scores at one or more visits. Majority Improved Dr. Segalla said 81% of patients completed the QOL questionnaires at week 7, compared with 58% at week 13 and 44% at the end of treatment. Almost all QOL domains improved with capecitabine treatment, the investigators found (see Table 1). On most scales, more than 70% of patients had stable or improved QOL scores. At least 40% of patients reported improvements from week 7 onwards in pain, fatigue, emotional functioning, arm symptoms (lymphe- dema), global health status, role functioning, and future perspective. QOL improvements were greatest in patients who had the worst ECOG (Eastern Coopertative Oncology Group) per- formance status (≥ 3) at baseline. "When cure is no longer feasible in the treatment of MBC, maintenance of QOL is important. The optimal palliative treatment should provide high efficacy with as little toxicity as possible, and it should improve QOL," Dr. Segalla said. "The efficacy, safety, and convenience benefits of capecitabine allow patients with MBC to maintain a normal lifestyle, and they have a direct impact on QOL. The QOL benefits of capecitabine are particularly important when choosing appropriate therapy for patients with incurable MBC."