Adding Xeloda to Standard Chemotherapy After Surgery for Triple-Negative Breast Cancer Seems to Improve Outcomes

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Adding Xeloda (chemical name: capecitabine) to the standard chemotherapy regimen after surgery to remove early-stage triple-negative breast cancer improved disease-free survival without causing any new side effects, according to a Chinese study.

The research was published online on April 10, 2020, by the Journal of Clinical Oncology. Read the abstract of “Adjuvant Capecitabine With Docetaxel and Cyclophosphamide Plus Epirubicin for Triple-Negative Breast Cancer (CBCSG010): An Open-Label, Randomized, Multicenter, Phase III Trial.”

Disease-free survival is how long a person lives without the cancer growing or coming back (recurring).

Triple-negative breast cancer is cancer that has no receptors for the hormones estrogen and progesterone, as well as no receptors for the HER2 protein. This limits the medicines that can be used to treat the cancer.

Doctors call treatments given after surgery adjuvant treatments.

About Xeloda

Xeloda is an antimetabolite chemotherapy. It kills cancer cells by acting as false building blocks in a cancer cell’s genes, causing the cancer cell to die as it gets ready to divide.

Xeloda is a pill taken by mouth.

About the study

Earlier studies have looked at adding Xeloda to standard chemotherapy after surgery for breast cancer overall, but this study looked specifically at adding Xeloda to standard chemotherapy after surgery for triple-negative breast cancer.

The study included 585 women who were diagnosed with early-stage triple-negative breast cancer between June 2012 and December 2013. About 55% of the women were premenopausal, and about 45% were postmenopausal.

All the women had breast cancer surgery:

  • about 23% had lumpectomy
  • about 77% had mastectomy
  • about 26% had sentinel lymph node biopsy
  • about 74% had axillary lymph node surgery

After surgery, the women were randomly assigned to one of two chemotherapy regimens:

  • 297 women were treated with three cycles of Xeloda plus Taxotere (chemical name: docetaxel), followed by three cycles of Xeloda, Ellence (chemical name: epirubicin), and Cytoxan (chemical name: cyclophosphamide); this was called the Xeloda treatment group
  • 288 women were treated with three cycles of Taxotere, followed by three cycles of fluorouracil, Ellence, and Cytoxan; this was called the standard treatment group

Half the women were followed for longer than 5.5 years, and half were followed for a shorter time.

At 5 years, disease-free survival rates were:

  • 86.3% for women in the Xeloda treatment group
  • 80.4% in the standard treatment group

This difference was statistically significant, which means that it was likely due to the difference in chemotherapy regimens and not just because of chance.

Overall:

  • 18 women in the standard treatment group had a recurrence in the same breast, compared to 7 women in the Xeloda treatment group
  • 37 women in the standard treatment group had a metastatic recurrence, meaning the breast cancer came back in a part of the body away from the breast, such as the bones or liver, compared to 29 women in the Xeloda treatment group

Side effects

About 97% of the women in each treatment group had side effects, including:

  • hair loss
  • low white blood cell counts
  • nausea
  • vomiting
  • constipation
  • peripheral neuropathy
  • fatigue
  • pain

The rates of all the side effects listed above were about the same in both treatment groups.

Women in the Xeloda treatment group were much more likely to have hand-foot syndrome, which is also called palmar-plantar erythrodysesthesia. Hand-food syndrome is a skin reaction that happens when a small amount of the chemotherapy medicine leaks out of small blood vessels, usually in the palms of the hands and the soles of the feet. The syndrome can cause numbness, tingling, pain, or a burning/itching sensation.

What this means for you

If you’ve been diagnosed with early-stage triple-negative breast cancer, it’s likely that you will have chemotherapy after surgery to reduce the risk of cancer recurrence. This study suggests that adding Xeloda to the standard chemotherapy regimen after surgery may reduce the risk of recurrence even more.

As you’re planning your treatment after surgery, you many want to talk to your doctor about this study and ask if adding Xeloda to your chemotherapy regimen makes sense for you and your unique situation.

For more information on chemotherapy regimens and medicines, visit the Breastcancer.org Chemotherapy pages.

Written by: Jamie DePolo, senior editor

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