Most elderly breast cancer patients would prefer oral chemotherapy such as capecitabine (Xeloda, Roche) over intravenous chemotherapy due to the convenience.
However, a clinical trial conducted in elderly women with early-stage breast cancer has found that standard adjuvant combination chemotherapy CMF (Cyclophosphamide & Methotrexate & 5-Fluorouracil) or C&D (cyclophosphamide and doxorubicin) were superior to the oral drug capecitabine in improving survival among older women.
The trial involved 600 women 65 years of age and older, randomized to either adjuvant therapy with capecitabine alone, or to 1 of 2 standard chemotherapy regimens (CMF or C&D).
After 3 years, the rate of relapse-free survival was 68% in the capecitabine group but 85% in the standard-chemotherapy groups. The overall survival rate was 86% and 91%, respectively.
Patients receiving capecitabine were twice as likely to have a relapse or die (HR = 2.09, 95% CI = 1.38 – 3.17; P < .001).
Nonetheless, the standard chemotherapies were associated with more adverse events. Twice as many patients receiving standard chemotherapy had moderate to severe toxic effects (64% vs 33% with capecitabine).
Adverse Effects in the 3 Study Groups:
|
Adverse Effect |
CMF (n = 132) |
C&D (n = 183) |
Capecitabine (n = 229) |
| Hematologic, % | 52 | 54 | 2 |
| Fatigue, % | 11 | 4 | 5 |
| Nausea and vomiting, % | 13 | 6 | 4 |
| Diarrhea, % | 8 | 3 | 7 |
| Hand–foot skin reaction, % | <1 | 0 | 16 |
| Febrile neutropenia, % | 8 | 9 |
1 |
Even though standard chemotherapies were associated with better survival results, these regimens might not be suitable for frail and vulnerable elderly breast cancer patients due to the adverse effects.
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Source: N Engl J Med. 2009;360:2055-2065.
