Abstract
Capecitabine is often offered as a first-line chemotherapy option for metastatic breast cancer (MBC). In this study, we compare characteristics of and survival among women prescribed first-line capecitabine or taxane monotherapy for MBC. Women receiving first-line chemotherapy for MBC from 1998 to 2005 were identified from the North Carolina tumor registry linked with Medicaid and Medicare claims records, and were followed through the end of 2005 with survival data from the National Death Index. T Tests and Chi-square tests were used to compare baseline characteristics. Overall survival and cancer-specific survival were examined using Cox proportional hazard modeling. There were 257 patients with MBC starting first-line chemotherapy with capecitabine (n = 71) or a taxane (n = 186). No differences in age, race, or Charlson comorbidity status were observed between groups. Hormone receptor negative tumors (31.0 vs. 17.7 %, p = 0.02) and patients insured by Medicaid (28 vs. 12 %, p = 0.002) were more prevalent in the capecitabine group. Time from metastasis to first-line chemotherapy was longer in the capecitabine group (52 vs. 26 % began after 3 months, p < 0.001). In multivariate analysis, treatment received was not associated with overall or cancer-specific survival. Among standard demographics, age was the only factor significantly associated with overall survival (HR 1.02, p = 04). In this population-based study, women who received capecitabine as first-line treatment for MBC were more often hormone receptor negative and insured by Medicaid. In multivariate analysis, first-line capecitabine and taxane for MBC yielded similar overall and cancer-specific survival outcomes.
References
Brewster AM, Hortobagyi GN, Broglio KR et al (2008) Residual risk of breast cancer recurrence 5 years after adjuvant therapy. J Natl Cancer Inst 100:1179–1183
Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96
Verma S, Clemons M (2007) First-line treatment options for patients with HER-2 negative metastatic breast cancer: the impact of modern adjuvant chemotherapy. Oncologist 12:785–797
Carrick S, Parker S, Thornton CE et al (2009) Single agent versus combination chemotherapy for metastatic breast cancer. Cochrane Database Syst Rev 15:CD003372
Cardoso F, Bedard PL, Winer EP et al (2009) International guidelines for management of metastatic breast cancer: combination vs sequential single-agent chemotherapy. J Natl Cancer Inst 101:1174–1181
Network NCC (2010) NCCN clinical practice guidelines in oncology 5th edn. Breast Cancer
Berthold D. Third consensus on medical treatment of metastatic breast cancer. Ann Oncol 21:665
Tkaczuk KH (2009) Review of the contemporary cytotoxic and biologic combinations available for the treatment of metastatic breast cancer. Clin Ther 31(2):2273–2289
Perez EA (1998) Paclitaxel in breast cancer. Oncologist 3:373–389
Seidman AD, Berry D, Cirrincione C et al (2004) Phase III study of weekly paclitaxel via 1-hour infusion versus standard 3 h infusion every third week in the treatment of metastatic breast cancer, with trastuzumab for HER2 positive MBC and randomized for trastuzumab in HER2 normal MBC. Proc Am Soc Clin Oncol 22:6s
Ghersi D, Wilcken N, Simes RJ (2005) A systematic review of taxane-containing regimens for metastatic breast cancer. Br J Cancer 93:293–301
Gick U, Rochlitz C, Mingrone W et al (2006) Efficacy and tolerability of capecitabine with weekly paclitaxel for patients with metastatic breast cancer: a phase II report of the SAKK. Oncology 71:54–60
Soto C, Torrecillas L, Reyes S, Ramirez M, Perez L, Cervantes G, Gonzalez F, Tellez E, Cortes P, Benitez H (2006) Capecitabine (X) and taxanes in patients (pts) with anthracycline-pretreated metastatic breast cancer (MBC): sequential versus combined therapy results from a MOSG randomized phase III trial. Proc Am Soc Clin Oncol 24:571
Stockler M, Sourjina T, Grimison P, Gebski V, Byrne M, Harvey V, Francis P, Nowak AK, Van Hazel G, Forbes J (2007) ANZ Breast Cancer Trials Group A randomized trial of capecitabine (C) given intermittently (IC) rather than continuously (CC) compared to classical CMF as first-line chemotherapy for advanced breast cancer (ABC). J Clin Oncol 25(18):1031
Jones A, O’Brien M, Sommer H et al (2010) Phase II study of oral vinorelbine in combination with capecitabine as second line chemotherapy in metastatic breast cancer patients previously treated with anthracyclines and taxanes. Cancer Chemother Pharmacol 65:755–763
Benekli M, Yildiz R, Uner A et al (2007) Gemcitabine plus capecitabine combination in metastatic breast cancer patients previously treated with anthracyclines and taxanes. Oncology 72:308–313
Lamont EB, Herndon JE 2nd, Weeks JC et al (2006) Measuring disease-free survival and cancer relapse using Medicare claims from CALGB breast cancer trial participants (companion to 9344). J Natl Cancer Inst 98:1335–1338
D’Hoore W, Bouckaert A, Tilquin C (1996) Practical considerations on the use of the Charlson comorbidity index with administrative data bases. J Clin Epidemiol 49:1429–1433
Talbot DC, Moiseyenko V, Van Belle S et al (2002) Randomised, phase II trial comparing oral capecitabine (Xeloda) with paclitaxel in patients with metastatic/advanced breast cancer pretreated with anthracyclines. Br J Cancer 86:1367–1372
Gornas M, Szczylik C (2010) Oral treatment of metastatic breast cancer with capecitabine: what influences the decision-making process? Eur J Cancer Care (Engl) 19:131–136
Schwartzberg LS, Cobb P, Walker MS et al (2009) Patient and practice impact of capecitabine compared to taxanes in first-/second-line chemotherapy for metastatic breast cancer. Support Care Cancer 17:1081–1088
Seidman AD, Berry D, Cirrincione C et al (2008) Randomized phase III trial of weekly compared with every-3-weeks paclitaxel for metastatic breast cancer, with trastuzumab for all HER-2 overexpressors and random assignment to trastuzumab or not in HER-2 nonoverexpressors: final results of Cancer and Leukemia Group B protocol 9840. J Clin Oncol 26:1642–1649
Fountzilas G, Dafni U, Dimopoulos MA et al (2009) A randomized phase III study comparing three anthracycline-free taxane-based regimens, as first line chemotherapy, in metastatic breast cancer: a Hellenic Cooperative Oncology Group study. Breast Cancer Res Treat 115:87–99
Beuselinck B, Wildiers H, Wynendaele W et al (2010) Weekly paclitaxel versus weekly docetaxel in elderly or frail patients with metastatic breast carcinoma: a randomized phase-II study of the Belgian Society of Medical Oncology. Crit Rev Oncol Hematol 75:70–77
Funding
The study was funded by Roche.
Conflict of interest
Drs. Kamal, Kimmick, Anderson, Camacho, and Balkrishnan have nothing to disclose. Dr. Wei was an employee of Roche during the period of the study analysis, who provided funding for the study. Dr. Wei was involved in the design of the study but did not participate in data collection or analysis.
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Kamal, A.H., Camacho, F., Anderson, R. et al. Similar survival with single-agent capecitabine or taxane in first-line therapy for metastatic breast cancer. Breast Cancer Res Treat 134, 371–378 (2012). https://doi.org/10.1007/s10549-012-2037-1
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DOI: https://doi.org/10.1007/s10549-012-2037-1