Capecitabine Versus Classical Cyclophosphamide, Methotrexate, and Fluorouracil As First-Line Chemotherapy for Advanced Breast Cancer

• Published in: Journal of clinical oncology Vol. 29; no. 34; pp. 4498 - 4504
• Main Authors: STOCKLER, Martin R, HARVEY, Vernon J, CORONA GAINFORD, M, FONG, Akiko, PAKSEC, Lisa, SOURJINA, Tatiana, ZANNINO, Diana, GEBSKI, Val, JOHN SIMES, R, FORBES, John F, COATES, Alan S, FRANCIS, Prudence A, BYRNE, Michael J, ACKLAND, Stephen P, FITZHARRIS, Bernie, VAN HAZEL, Guy, WILCKEN, Nicholas R. C, GRIMISON, Peter S, NOWAK, Anna K
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 01-12-2011
• Subjects: Aged; Antimetabolites, Antineoplastic - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Breast Neoplasms - drug therapy; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Capecitabine; Cisplatin - therapeutic use; Deoxycytidine - administration & dosage; Deoxycytidine - analogs & derivatives; Deoxycytidine - therapeutic use; Disease-Free Survival; Drug Administration Schedule; Female; Fluorouracil - administration & dosage; Fluorouracil - analogs & derivatives; Fluorouracil - therapeutic use; Gynecology. Andrology. Obstetrics; Humans; Mammary gland diseases; Medical sciences; Methotrexate - therapeutic use; Middle Aged; Tumors; Antineoplastic agent; Breast disease; Capecitabine; Antifolate; Cancerology; Advanced stage; Methotrexate; Pyrimidine nucleoside; Fluorouracil; Enzyme; Fluoropyrimidine derivatives; Transferases; Enzyme inhibitor; Breast cancer; Malignant tumor; Prodrug; Thymidylate synthase; First line treatment; Mammary gland diseases; Alkylating agent; Oxazaphosphinane derivatives; Cyclophosphamide; Antimetabolic; Methyltransferases; Nitrogen mustard; Pyrimidine derivatives; Comparative study; Cancer
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2010.33.9101

We compared oral capecitabine, administered intermittently or continuously, versus classical cyclophosphamide, methotrexate, and fluorouracil (CMF) as first-line chemotherapy for women with advanced breast cancer unsuited to more intensive regimens.
Three hundred twenty-three eligible women were randomly assigned to capecitabine administered intermittently (1,000 mg/m(2) twice daily for 14 of every 21 days; n = 107) or continuously (650 mg/m(2) twice daily for 21 of every 21 days; n = 107), or to classical CMF (oral cyclophosphamide 100 mg/m(2) days 1 to 14 with intravenous methotrexate 40 mg/m(2) and fluorouracil 600 mg/m(2) on days 1 and 8 every 28 days; n = 109). The primary end point was quality-adjusted progression-free survival (PFS); secondary end points included PFS, overall survival (OS), objective tumor response, and adverse events. Intermittent and continuous capecitabine were to be compared first and, if similar (P > .05), combined for definitive comparisons versus CMF.
Quality-adjusted PFS (P = .2), objective tumor response rate (20%; P = .8), and PFS (median, 6 months; hazard ratio [HR], 0.86; 95% CI, 0.67 to 1.10; P = .2) were similar in women assigned capecitabine versus CMF. OS was longer in women assigned capecitabine rather than CMF (median, 22 v 18 months; HR, 0.72; 95% CI, 0.55 to 0.94; P = .02). Febrile neutropenia, infection, stomatitis, and serious adverse events were more common with CMF; hand-foot syndrome was more common with capecitabine.
Capecitabine improved OS by being similarly active, less toxic, and more tolerable than CMF. Capecitabine is a good first-line chemotherapy option for women with advanced breast cancer who are unsuited to more intensive regimens.