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Breast Cancer Update 2006 (7)

DR CARLSON: Capecitabine has efficacy that is in the ballpark of any single agent, and I tend to treat metastatic breast cancer that’s not in visceral crisis with single-agent therapy. The toxicity profile of capecitabine is favorable, and the women appreciate being able to take an oral medication, not having to go to the infusion center and not having to come back as frequently. It’s an agent that, at doses that are typically used, is associated with a predictable toxicity experience. I use 1,000 mg/m² twice daily — two weeks out of three weeks.

Capecitabine also doesn’t generally cause alopecia, which is important. If you’re going to use sequential single agents, it’s nice to start with an agent that doesn’t cause alopecia. If the woman already has alopecia, you don’t gain from the nonalopecia properties of the new therapy. That’s an important component of treatment for metastatic disease.

The other reason I often lead with capecitabine is that many of these women, because it’s the first-line therapy, have recently been diagnosed with their metastasis. They will go through all the turmoil and psychic trauma of the new diagnosis, and in that context, it is often easier to start with an agent that has acceptable toxicity, so they can become used to the chronic nature of the disease and the need for ongoing chemotherapy with an agent that has good efficacy and doesn’t affect their quality of life to a major degree.

Breast Cancer Update 2007 (4)

DR O’REGAN: When you consider the ECOG-E2100 trial, the progression-free survival increase of nearly six months is impressive. Certainly this benefit may be compared to the combination versus single-agent chemotherapy studies we’ve conducted before in metastatic breast cancer.

Most of the patients I’ve treated have shown at least some type of a response, although perhaps not as sustained as we would like. I also like bevacizumab because its toxicity doesn’t overlap with that of the chemotherapy. Apart from a little hypertension and some headaches, patients tolerate it well.

I’ve used it almost exclusively in the first-line setting with paclitaxel. For a couple of patients, I’ve used it outside of the first-line setting, but as you would expect, we do not obtain many responses.

Bevacizumab would probably work out fine administered with capecitabine. Unfortunately, we have a somewhat negative trial in the second-line setting with bevacizumab and capecitabine, although a response-rate improvement was evident in that trial. I believe it’s the line of therapy used rather than the agent you use it with that’s important.

If a patient continues to respond, I continue both agents until disease progression, as was done on the trial. Of course, the big question is whether you could drop the chemotherapy and continue the bevacizumab, but I haven’t done that. In some ways, it may make more sense to continue the bevacizumab on its own, but that must be addressed in a trial.

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