Breast Cancer Update

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Section 2
Risk and Benefits of Capecitabine in Metastatic Disease

INTEGRATION INTO MANAGEMENT ALGORITHM

The response rate of 20 to 30 percent that seems to be reported in multiple studies of capecitabine includes many patients who have been heavily treated. So for patients who’ve had anthracyclines and taxanes and possibly even other agents, there now is an opportunity to induce a remission with an oral drug that doesn’t cause hair loss, myelosuppression and the threat of neutropenic fever.

Also, I believe there’s a role in appropriate patients for capecitabine early on — although it’s not FDA-approved for that use. We know that none of the therapies in metastatic breast cancer will cure patients — whether it be taxanes or anything else. They’re all palliative therapies.

And for a woman who has lost her hair once and now has to deal with the depression, frustration and fear that comes with the diagnosis of recurrence, the availability of a kinder, gentler oral drug that doesn ’t have a myriad of symptoms is a very good option.

And so I think it’s a reasonable thought,even in younger women. Depending on the clinical status of the patient,capecitabine is perfectly reasonable to use in any patient in the metastatic setting, provided quality-of-life issues are key.

—Hyman Muss, MD

The median duration of response is about eight to nine months in responders to capecitabine.15 However, all of us who have used a lot of this agent have patients whose responses lasted well over a year and even two years or more.There is a subset of patients who do remarkably well on the right dose of capecitabine for a long period of time.Tethering a patient to intravenous therapy — whether weekly or every three weeks — is certainly a step down in the quality of life.

And so I have used single-agent capecitabine in women who are HER2 non-overexpressing with relatively indolent, fairly small volume, asymptomatic disease to keep quality of life as high as possible. I also have many older patients whose first-line chemotherapy for metastatic disease was capecitabine, because they didn’t want IV therapy, alopecia and nausea.

—Joyce O’Shaughnessy, MD