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Query: UMLS:C0278488 (metastatic breast cancer)
 7,812 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Capecitabine is approved as a single agent and in combination with docetaxel for the treatment of metastatic breast cancer. Preclinical and clinical research suggests that the activity of capecitabine is enhanced in combination with taxanes and several biochemical mechanisms of synergy have been described. Recent data suggest that novel doses and schedules os capecitabine can improve safety without compromising efficacy. More than 50 publications and abstracts describing capecitabine/taxane combination therapy studies were reviewed to evaluate the available data on efficacy, safety, and quality of life for patients with breast cancer. Several ongoing randomized adjuvant and neoadjuvant clinical trials are assessing the clinical utility of capecitabine/taxane combinations in early-stage and locally advanced breast cancer.
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PMID:Capecitabine/Taxane combination therapy: evolving clinical utility in breast cancer. 1676 43

Capecitabine is a novel, orally administered fluoropyrimidine carbamate that has been approved for adjuvant treatment in patients with Stage III colon cancer, first-line metastatic colorectal cancer, and metastatic breast cancer, both as a single agent (for patients who are resistant to paclitaxel and anthracyclines) and in combination with docetaxel (after failure on anthracycline-based therapy). Capecitabine is being investigated in Phase I and II trials for the treatment of gastric, gastroesophageal, and esophageal cancers, primarily in the first-line metastatic setting but also in the adjuvant setting. The MEDLINE data base was searched for English-language clinical trials that were published from 1996 through October 2005 along with relevant abstracts that were presented at the American Society of Clinical Oncology and at meetings of the European Cancer Conference and the European Society of Medical Oncology. The most frequently investigated combinations were capecitabine with docetaxel, paclitaxel, cisplatin, or oxaliplatin, and capecitabine also has been combined with irinotecan. These therapies have yielded efficacy data that compare favorably with data from Phase III trials of parenteral 5-fluorouracil (5-FU) in the first-line metastatic setting, and they mostly are well tolerated. Capecitabine, when combined in doses <1250 mg/m(2) twice daily, consistently resulted in a lower frequency of Grade 3 or 4 toxic effects. Capecitabine, as a representative of oral fluoropymidine, is a promising agent in gastroesophageal cancers. Although some Phase III trials are completed, additional Phase III trials of capecitabine-based combinations that compare its efficacy and safety with parenteral 5-FU-based combinations, in both first-line metastatic and adjuvant settings, would be important.
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PMID:Review of capecitabine as oral treatment of gastric, gastroesophageal, and esophageal cancers. 1677 Jul 84

Capecitabine has proven efficacy in metastatic breast cancer, extending survival in combination with docetaxel and offering a favorable safety profile, including minimal myelosuppression and alopecia, as a single agent. It is therefore logical that capecitabine could build on the improved outcomes achieved with taxanes in early breast cancer. In the neoadjuvant setting, a phase III trial of capecitabine and docetaxel (XT) versus doxorubicin and cyclophosphamide (AC) showed that XT was more effective than AC in terms of clinical response rate and pathologic complete response rate, with a manageable safety profile. Other studies, including a phase III trial of capecitabine, epirubicin, and docetaxel, a phase III trial of capecitabine and vinorelbine, and several phase II studies of different regimens with capecitabine, have confirmed the high activity of neoadjuvant capecitabine, with acceptable safety. In the adjuvant setting, a Finnish phase III study (FinXX) of sequential XT followed by cyclophosphamide, epirubicin, and capecitabine versus docetaxel followed by 5-fluorouracil, epirubicin, and cyclophosphamide has shown favorable safety with lower doses of both capecitabine and docetaxel in the XT combination. Efficacy results from that trial are eagerly awaited. A large, ongoing trial program is continuing to explore the potential for capecitabine in the treatment of early breast cancer, looking at capecitabine-taxane combinations, capecitabine maintenance therapy, capecitabine for elderly patients, and sequential versus combination therapy, involving >20,000 patients.
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PMID:Capecitabine: expanding options for the treatment of patients with early or locally advanced breast cancer. 1697 36

Capecitabine is an important drug in the therapeutic armamentarium for metastatic breast cancer. A comprehensive worldwide clinical trial program involving >10,000 patients with locally advanced and metastatic breast cancer has provided evidence for the current treatment strategies. On the basis of data demonstrating consistent activity across several trials in patients with heavily pretreated breast cancer, capecitabine was approved in the U.S. in 1998 for the treatment of patients with metastatic disease resistant to paclitaxel and anthracycline-containing therapy, with later European Union approval for single-agent capecitabine in the metastatic setting. Capecitabine plus docetaxel (XT) was approved by the U.S. Food and Drug Administration for the treatment of metastatic breast cancer in 2001 on the basis of the large phase III trial comparing XT with docetaxel alone, which showed a survival advantage for combination therapy compared with single-agent therapy. This was shortly followed by European approval for the combination in metastatic breast cancer. The clinical utility of capecitabine in the management of breast cancer is supported by its convenient oral dosing schedule and favorable safety profile, as well as its excellent clinical activity in primary and metastatic breast cancer. Recently, clinical trials have studied single-agent capecitabine as first-line treatment and evaluated other capecitabine-containing combinations with cytotoxic and novel targeted agents.
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PMID:The role of capecitabine in first-line treatment for patients with metastatic breast cancer. 1697 39

Metastatic breast cancer develops in approximately 50% of women diagnosed with breast cancer. The optimal treatment for patients with metastatic breast cancer has yet to be defined, owing to the heterogeneity of this group and the available agents. Patients with metastatic breast cancer often receive single-agent treatment in sequence as it is unclear whether combination therapy with cytotoxic drugs offers an overall disease-free survival benefit and single agents may offer less toxicity. The advantages of combination cytotoxic therapies have included higher response rates. However, such trials have not stratified on rapidity of disease progression or on tumor bulk. In previous studies, docetaxel is one of the few cytotoxic agents to demonstrate a survival benefit in anthracycline-resistant patients and thus it has become a vital component of cytotoxic therapy. Capecitabine is also an important oral drug and has demonstrated activity in patients pretreated with anthracyclines and taxanes. Recent preclinical and clinical trials of this combination have demonstrated an increased time to tumor progression and overall survival benefit. Paclitaxel combined with gemcitabine has been compared with docetaxel plus capecitabine, with similar response rates and survival benefits. As patients on these trials have not received uniform crossover to the other active agent, whether or not the combination therapy offers an advantage for the entire cohort of metastatic patients or may be indicated for specific subgroups remains uncertain. Combination treatments may be preferable to sequential therapy for patients requiring urgent reduction in their tumor burden. Combinations of cytotoxic agents in combination with biological agents are currently being defined.
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PMID:Capecitabine-docetaxel combination treatment. 1702 Apr 52

Capecitabine is converted to 5-fluorouracil by thymidine phosphorylase, and mitomycin C is capable of upregulating the expression of thymidine phosphorylase suggesting a synergistic effect. Fifty-three patients (median age 62 years) with anthracycline- and taxane-resistant, metastatic breast cancer received mitomycin C 6 mg/m(2) on day 1, and capecitabine (Xeloda) 2,000 mg/m(2)/day from day 1 to day 14 with cycles repeated every 4 weeks. Overall, 77.4% had visceral metastases and 33 were pretreated with >/=3 chemotherapy lines. A median of 6 cycles were given (range 1-19) with a complete response observed in 2 patients (3.9%), partial response in 17 (33.3%) and stable disease in 19 (37.2%). Overall response rate was 37.2% (95% CI, 24.0-50.5%), with a median duration of 10.4 months. Median time to progression was 8.1 months and median survival was 17.4 months (1- and 2-year survival rates of 60 and 28%, respectively). Toxicity was mild. The most frequent grade 3/4 events were neutropenia (5.7% of patients), diarrhea (3.8%), and deep venous thrombosis (3.8%). Capecitabine plus mitomycin C may represent an effective and manageable treatment option for advanced breast cancer patients resistant to anthracyclines and taxanes. This approach provides an alternative for pretreated patients with advanced breast cancer.
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PMID:Capecitabine and mitomycin C is an effective combination for anthracycline- and taxane-resistant metastatic breast cancer. 1704

Primary goals of treatment in metastatic breast cancer include prevention and palliation of symptoms, maintenance or improvement of quality of life and prolongation of survival. In order to account for the variability of clinical courses, treatment decisions have to be made on an individual basis. Low risk patients without evidence of rapid disease progression or symptomatic disease are mainly considered for endocrine treatment or single agent chemotherapy, whereas patients at higher risk with rapidly progressive or symptomatic disease are candidates for poly-chemotherapies. Anthracyclines are one of the most active group of agents and remain active after adjuvant pre-treatment. The use of liposomal derivatives or weekly or prolonged application can decrease the risk of cardiotoxicity. There is only incomplete cross-resistance between anthracyclines and taxanes. Taxane-based weekly or 3 weekly regimens are therefore generally used in anthracycline-pretreated patients. Capecitabine, gemcitabine, or vinorelbine constitute candidate agents after failure of anthracyclines and/or taxanes and may result in objective responses or disease stabilisation. Data on the continuation beyond third-line chemotherapy are insufficient. Decisions have therefore to be made on an individual basis.
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PMID:[Chemotherapy for metastatic breast cancer]. 1721 69

At present there is no established standard of care for metastatic breast cancer and prognosis remains poor, although the use of newer chemotherapeutic regimens has led to modest improvements in survival. Capecitabine, an oral prodrug of 5-fluorouracil, is a promising addition to these approaches, having already shown single-agent activity against metastatic breast cancer. Following a pivotal trial demonstrating that capecitabine confers increased survival when used in combination with docetaxel, it is being investigated intensively in combined regimens using other standard chemotherapeutic agents, as well as with novel molecularly targeted therapies. Among the novel agents, the most intensively studied in combination with capecitabine is trastuzumab. Despite preclinical data suggesting that these two agents might not show additive effects, clinical trials have been very encouraging for both heavily pretreated patients and for patients receiving first-line therapy in the metastatic setting. This work is being further extended in an ongoing trial in the neoadjuvant setting. An initial trial in combination with bevacizumab, enrolling heavily pretreated patients, was less successful, but following the example of the E2100 trial, this combination is being re-examined in less heavily treated patients. In addition, this review discusses ongoing trials with an array of newer molecularly targeted agents. Significant improvement in time to progression has already been demonstrated in the combination of lapatinib and capecitabine compared with capecitabine monotherapy; for the most part, however, these trials are still in early stages.
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PMID:Capecitabine in combination with novel targeted agents in the management of metastatic breast cancer: underlying rationale and results of clinical trials. 1747 Jun 80

Capecitabine was developed as a prodrug of 5-fluorouracil (FU), with the goal of improving tolerability and intratumour drug concentrations through tumour-specific conversion to the active drug against numerous types of neoplasms. The most frequent adverse cutaneous reaction associated with capecitabine is hand foot syndrome (HFS), presented with symmetrical erythema, dysaesthesia, and desquamation on the palms and soles. Acquired palmoplantar keratoderma (PPK) can occur in various dermatoses associated with metabolic abnormalities, malignancies, and toxic agents. However, there has been no report of PPK after capecitabine chemotherapy. We report two cases of diffuse PPK, which developed in patients with metastatic breast cancer after one cycle of capecitabine chemotherapy. Because oral capecitabine is increasingly used for various solid tumours, clinicians should be aware that keratoderma can develop during capecitabine chemotherapy as a sequential event of HFS.
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PMID:Capecitabine-induced diffuse palmoplantar keratoderma: is it a sequential event of hand-foot syndrome? 1750 60

We report a case of elderly metastatic breast cancer with a complete response to the treatment with XC (X: capecitabine and C: cyclophosphamide). A 78-year-old woman, who presented with left breast cancer, underwent pectoralis-preserving mastectomy when she was 76 years old. Pathological findings were as follows: invasive ductal carcinoma (scirrhous type), pT1c (2.0 cm), n (1/10), ly3, v1, ER (-), PgR (-), HER2: score 1. After one year and a half, a left supraclavicular lymph node metastasis, a left interpectoral lymph node metastasis, and mediastinal lymph nodes metastasis were noted. Capecitabine and cyclophosphamide were administered as first-line chemotherapy. After 8 cycles, all metastases responded, and this therapy is now being continued (19 cycles) on an outpatient basis. The complete response has continued for nine months. XC therapy can be the first-line chemotherapy for elderly metastatic breast cancer patients since it has been effective and no serious side effects have been encountered while maintaining quality of life.
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PMID:[A case of elderly metastatic breast cancer with a complete response to treatment with capecitabine and cyclophosphamide]. 1794 Mar 94


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