In a nutshell
This trial compared standard chemotherapy regimens and Capecitabine (Xeloda) in women over 65 years old. The main outcome was that standard chemotherapy worked better in this age group.
Capecitabine is generally used in breast cancer resistant to other chemotherapy. It is also the first approved treatment that can be given orally (it comes in a pill form). Standard chemotherapy for breast cancer usually includes one of these two regimens:
1. Cyclophosphamide (Cytoxan), Methotrexate, and Fluorouracil (Efudex) – CMF
2. Doxorubicin (Adriamycin) and Cyclophosphamide – DC
These treatments are given in addition to surgical removal of the tumor. The goal of chemotherapy is to destroy remaining cancer cells and prevent a relapse (recurrence of the cancer after a cancer-free period). The choice of chemotherapy over other treatments depends on some features of the tumor, such as its extent and absence of hormone receptors.
Methods & findings
This study, conducted from 2001 to 2006, included 633 patients who received either Capecitabine or one of the standard chemotherapy regimens (CMF or DC). The patients had early-stage breast cancer and two thirds were over 70. After 3 years, relapse rates were higher in women who received only Capecitabine: 68% of patients had no relapse versus 85% in the standard chemo group. Overall survival rates were also lower for Capecitabine: 86% versus 91% (standard chemotherapy).
Standard chemotherapy also worked better in cancers that do not respond to hormone treatments. Despite the better efficacy of standard chemotherapy, its toxicity was higher.
The bottom line
In older women, standard chemotherapy works better than Capecitabine. However, at this age, toxicity is much harder to tolerate.
The fine print
One potential limitation of the study is that not all patients were able to complete the treatment due to toxic effects. For older patients, side effects and drug efficacy are crucial aspects in therapy choice.
Published By :
The New England Journal of Medicine
May 14, 2009
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