title: First-line capecitabine monotherapy for slowly progressing metastatic breast cancer: do we need aggressive treatment?
abstract: BACKGROUND
  Primary treatment goals in less aggressive metastatic breast cancer (MBC) are prolonged survival, good quality of life and control of the disease and its symptoms. High activity, oral administration and no alopecia make capecitabine monotherapy attractive in slowly evolving disease.
  
  
  METHODS
  We retrospectively analysed 226 patients who had received single-agent capecitabine as 1st-line chemotherapy at our institution.
  
  
  RESULTS
  The median interval between breast cancer diagnosis and MBC was 52 months (range 0-479); 76% had received endocrine therapy for MBC, 58% had visceral involvement and 30% had 3 or more metastatic sites. The median starting dose was 1,000 mg/m(2) twice daily. Disease was improved in 56% of the patients (median duration: 13.2 months) and stabilised in 20%. Median time to treatment failure was 8.8 months (95% CI: 7.1-10.5); median overall survival from initiating capecitabine was 23.6 months (95% CI: 19.7-27.4). Prior adjuvant chemotherapy, endocrine therapy for MBC, visceral disease, hormone receptor status and initial capecitabine dose did not influence time to treatment failure. Among 161 patients <75 years, 90% received further chemotherapy.
  
  
  CONCLUSIONS
  Based on these findings, 1st-line capecitabine should be considered in slowly progressing disease, offering an active, well-tolerated oral treatment with minimal toxicity and no alopecia. More toxic treatments may be reserved for more aggressive disease.
authors: Department of Medical Oncology, Institut Bergonié, South-West Comprehensive Cancer Center, Bordeaux, France. debled @ bergonie.org
authors: Marc
authors: M
authors: Debled
authors: Nicolas
authors: N
authors: Madranges
authors: Alexandra
authors: A
authors: Trainaud
authors: Anne
authors: A
authors: Floquet
authors: Catherine
authors: C
authors: Donamaria
authors: Véronique
authors: V
authors: Brouste
authors: Michel
authors: M
authors: Durand
authors: Louis
authors: L
authors: Mauriac
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000523:psychology; D000069287:Capecitabine; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil