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Spotlight on Capecitabine in the Management of Advanced Breast Cancer

  • Adis Spotlight
  • Published:
American Journal of Cancer

Abstract

Capecitabine is an orally administered prodrug of fluorouracil which is indicated in the US and Europe, in combination with docetaxel, for the treatment of patients with metastatic breast cancer failing anthracycline therapy, and as monotherapy for metastatic breast cancer resistant to paclitaxel and anthracycline therapy (US) or failing intensive chemotherapy (Europe). Capecitabine is also approved for use in metastatic colorectal cancer. Capecitabine is metabolically activated preferentially at the tumor site, and shows antineoplastic activity and synergy with other cytotoxic agents including cyclophosphamide or docetaxel in animal models. Bioavailability after oral administration is close to 100%.

In patients with pretreated advanced breast cancer, capecitabine is effective as monotherapy and also in combination with other agents. Combination therapy with capecitabine 1250 mg/m2 twice daily for 2 weeks of every 3-week cycle plus intravenous docetaxel 75 mg/m2 on day one of each cycle was superior to intravenous monotherapy with docetaxel 100 mg/m2 on day one of each cycle. Capecitabine plus docetaxel significantly reduced the risks of disease progression and death by 35% (p = 0.0001) and 23% (p < 0.05), respectively, and significantly increased median survival (p < 0.05) and objective response rates (p < 0.01). Efficacy has also been demonstrated with capecitabine monotherapy and combination therapy in previously untreated patients in preliminary trials.

The most common adverse effects occurring in patients receiving capecitabine monotherapy include lymphopenia, anemia, diarrhea, hand-and-foot syndrome, nausea, fatigue, hyperbilirubinaemia, dermatitis and vomiting (all >25% incidence). While gastrointestinal events and hand-and-foot syndrome occurred more often with capecitabine than with paclitaxel or a regimen of cyclophosphamide, methotrexate and fluorouracil (CMF), neutropenic fever, arthralgia, pyrexia and myalgia were more common with paclitaxel, and nausea, stomatitis, alopecia and asthenia were more common with CMF. The incidence of adverse effects and hospitalization was similar in patients receiving capecitabine plus docetaxel and those receiving docetaxel monotherapy.

In conclusion, capecitabine, an oral prodrug of fluorouracil which is activated preferentially at the tumor site, is an effective and convenient addition to the intravenous polychemotherapeutic treatment of advanced breast cancer in pretreated patients, and also has potential as a component of first-line combination regimens. Combined capecitabine plus docetaxel therapy resulted in similar rates of treatment-related adverse effects and hospitalization to those seen with docetaxel monotherapy. Capecitabine is also effective as monotherapy in pretreated patients and phase II data for capecitabine as first-line monotherapy are also promising. While gastrointestinal effects and hand-and-foot syndrome occur often with capecitabine, the tolerability profile was comparatively favorable for other adverse effects (notably, neutropenia and alopecia).

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Acknowledgments

The full text article in Drugs 2003; 63 (2): 217-36 was reviewed by: D.R. Budman, Don Monti Division of Oncology, North Shore University Hospital, New York, New York, USA; F.M. Muggia, Kaplan Cancer Center, New York, New York, USA; D. Papamichael, Department of Medical Oncology, BOC Oncology Centre, Strovolos, Nicosia, Cyprus; P.N. Plowman, Department of Radiotherapy, St. Bartholomew’s Hospital, London, England; C. Twelves, Department of Medical Oncology, Cancer Research UK, Glasgow, Scotland.

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Authors and Affiliations

  1. Adis International Inc., 860, Town Center Drive, Langhorne, PA, 19047, USA

    Antona J. Wagstaff, Tim Ibbotson & Karen L. Goa

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  1. Antona J. Wagstaff
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  2. Tim Ibbotson
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  3. Karen L. Goa
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Correspondence to Antona J. Wagstaff.

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This Spotlight is derived from abstract and summary text of an Adis Drug Evaluation originally published in full in Drugs 2003; 63 (2): 217–36.

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Wagstaff, A.J., Ibbotson, T. & Goa, K.L. Spotlight on Capecitabine in the Management of Advanced Breast Cancer. Am J Cancer 2, 137–140 (2003). https://doi.org/10.2165/00024669-200302020-00008

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  • DOI: https://doi.org/10.2165/00024669-200302020-00008

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