Triple-negative Breast Cancer: Adjuvant Capecitabine May Improve Outcomes

Adding capecitabine to a docetaxel, epirubicin, and cyclophosphamide adjuvant therapy combination may improve outcomes for patients with triple-negative breast cancer, according to a study published in JAMA Oncology.¹

Some evidence shows that capecitabine increases fluorouracil concentration within tumors, potentially improving outcomes for patients in the adjuvant setting if used in conjunction with paclitaxel, docetaxel, and cyclophosphamide. For the FinXX trial (ClinicalTrials.gov Identifier: NCT00114816) researchers evaluated whether 3 cycles of docetaxel and capecitabine followed by 3 cycles of cyclophosphamide, epirubicin, and capecitabine is a superior regimen to 3 cycles of docetaxel followed by 3 cycles of cyclophosphamide, epirubicin, and fluorouracil.

Fifteen hundred patients who were treated surgically were randomly assigned to the capecitabine group (753 patients) or to the fluorouracil group (747 patients). Median follow-up post-randomization was about 10 years; the main outcome was recurrence-free survival.

During follow-up there were 144 cases of recurrence and 122 deaths among patients in the capecitabine group; there were 164 cases of recurrence and 142 deaths in the fluorouracil group. Differences in recurrence-free survival were not, however, significant.

An exploratory subgroup analysis showed that patients with triple-negative breast cancer benefited from capecitabine: 39 of 109 patients with triple-negative disease had recurrence or died in the fluorouracil group compared with 20 of 93 patients in the capecitabine group.

The authors concluded that while capecitabine did not improve overall outcomes in the adjuvant setting, patients with triple-negative breast cancer may benefit from a regimen including capecitabine. Further research is warranted.

Reference

1. Joensuu H, Kellokumpu-Lehtinen PL, Huovinen R, et al. Adjuvant capecitabine in combination with docetaxel, epirubicin, and cyclophosphamide for early breast cancer: the randomized clinical FinXX trial. JAMA Oncol. 2017 Mar 2. doi: 10.1001/jamaoncol.2016.6120 [Epub ahead of print]