Abstract
Purpose
Capecitabine has extensive utilization in the treatment of diverse solid tumors, and its efficacy has been substantiated. Its oral administration and minimal toxicity in clinical practice render it advantageous. Nevertheless, uncertainty remains regarding whether capecitabine can substitute anthracycline drugs in chemotherapy regimens to achieve a lower risk of anthracycline-induced degradation. Consequently, we conducted a meta-analysis of randomized controlled trials (RCTs) to assess the potential of capecitabine as a replacement for anthracycline drugs in chemotherapy regimens for breast cancer.
Methods
We systematically searched PubMed, Embase, Web of Science, and the Cochrane Controlled Trials Register (CENTRAL) to retrieve eligible studies published before July 18, 2023. Two independent reviewers extracted relevant data from the included studies using a pre-established data extraction form. The primary endpoints of interest encompassed overall survival (OS) and progression-free survival (PFS) for postoperative adjuvant therapy, as well as pathological complete response (PCR) following neoadjuvant therapy. Adverse events were considered as secondary outcomes. The statistical analysis was performed using Revman 5.4.1.
Results
A total of six studies involving 2348 breast cancer patients were deemed eligible according to the selection criteria. The pooled meta-analysis revealed that there were no statistically significant differences observed in the primary outcomes of overall survival (OS) (HR 1.06, 95% CI 0.88–1.28) and progression-free survival (PFS) (HR 1.10, 95% CI 0.90–1.34) across the four postoperative adjuvant chemotherapy trials, as well as in the two neoadjuvant chemotherapy trials with respect to the primary outcome of pathological complete response (PCR) (OR 1.65, 95% CI 0.93–2.95) when comparing regimens containing anthracycline drugs to those without. In terms of adverse events, the probability of experiencing diarrhea (OR 3.94, P = 0.004) and hand-foot syndrome (OR 10.89, P = 0.004) was significantly higher in the capecitabine group, attributable to the drug characteristics. Conversely, the likelihood of developing neutropenia (OR 0.50, P = 0.03) was higher in the anthracycline group.
Conclusions
According to the current evidence, there was no statistically significant difference in the primary outcomes when capecitabine was substituted for anthracycline drugs. Thus, capecitabine can be regarded as a feasible alternative in the subset of patients who necessitate the exclusion of anthracyclines.
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Data availability
The datasets used and analyzed during the current study are available from the first author on reasonable request.
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Funding
This study was supported in part by Clinical Research Center for Breast and Thyroid Disease Prevention and Control in Hunan Province Grant No. 2018sk4001. Apart from that, there is no other funding.
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SW provided the conceptualization and design of the article. YZ provided an overview of the current status of chemotherapy in breast cancer. SW and YL conducted the retrieval of RCT studies as requested. LD and JC performed the assessment of literature quality. HC and YW critically revised the manuscript. SW compiled and analyzed all the data, and was the primary contributor in writing the manuscript. All authors contributed to this article and have approved the submitted version.
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Wang, S., Deng, L., Chen, J. et al. Role and efficacy of capecitabine in the anthracycline-free regimen in breast cancer patients: a systematic review and meta-analysis. J Cancer Res Clin Oncol 149, 17671–17682 (2023). https://doi.org/10.1007/s00432-023-05459-7
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DOI: https://doi.org/10.1007/s00432-023-05459-7