SABCS 2019 – Add-on capecitabine effective in early TNBC


  • Ben Gallarda
  • Univadis
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Takeaway

  • Widely used capecitabine shown to improve disease-free survival (DFS) when added to standard (neo)adjuvant chemotherapy in early triple-negative breast cancer (TNBC).
  • Results come from meta-analysis of 12 trials including over 15,000 patients, nearly 4,000 of whom had TNBC.

Why this matters

  • TNBC's lack of druggable targets limits treatment options; aggressive disease and worse outcomes drive the search for effective treatments.
  • Evidence from this study supports some current treatment guidelines.
  • Capecitabine has been studied in numerous early breast cancer trials but this is the first meta-analysis on its efficacy using individual patient data.

Key results

  • Adding capecitabine to standard (neo)adjuvant chemotherapy in early TNBC (7 studies, n=2953):
    • Improves DFS by 18% (HR, 0.82; 95% CI, 0.71-0.94; P=.004).
    • Improves OS by 22% (HR, 0.78; 95% CI, 0.66-0.92; P=.004).
  • No benefit seen with use of capecitabine instead of standard chemotherapy (5 studies, n=901).

Study design

  • Meta-analysis of individual patient data from 12 randomized trials (n=15,457, TNBC n=3854)
  • Primary objective: effect of capecitabine on DFS; secondary objective: effect of capecitabine on OS.
  • Subsets: capecitabine plus standard chemotherapy (7 studies, n=9421); capecitabine instead of another chemotherapy (5 studies, n=6032).

Limitations

  • Results presented at a conference without peer review.

Expert commentary

  • In response, Harold Burstein of the Dana-Farber Cancer Institute in Boston commented on Twitter, “MAJOR FINDING...We have undervalued this approach because all-comers trials rarely showed a benefit. Big news for #TNBC #SABCS19”.