Standard chemotherapy more effective than capecitabine for older women

Older women with early-stage triple negative breast cancer had four times the chance of relapse if they were treated with the chemotherapy drug capecitabine (Xeloda ) rather than standard chemotherapy, either cyclophosphamide/methotrexate/fluorouracil, or doxorubicin/cyclophosphamide. Their risk of death was three times higher, according to data published in the May 14 issue of The New England Journal of Medicine.

Capecitabine is taken orally.

Women 65 and older were randomly assigned to standard chemotherapy or capecitabine . Among the patients in the standard chemotherapy group, 133 chose cyclophosphamide/methotrexate/fluorouracil, 184 chose doxorubicin/cyclophosphamide and nine withdrew without choosing a treatment.

CMF was administered in standard doses for six cycles repeated every six weeks.

AC was administered in standard doses for four cycles repeated every three weeks.

Capecitabine was administered in two divided doses for 14 consecutive days every three weeks for six cycles. 

Patients were evaluated at an average of 2.5 years. For all women regardless of receptor status, those in the capecitabine group had double the risk for recurrence and a similar risk for death. Breast cancer was the most common cause of death in the capecitabine group compared with other cancers or cardiovascular disease for patients in the standard chemotherapy group. 

But when women were further evaluated by receptor status, those in the triple negative group fared even worse, with four times the risk of recurrence and three times the risk of death.

Standard chemotherapy also resulted in increased estimated three-year relapse-free survival (85 percent vs. 68 percent) and overall survival (91 percent vs. 86 percent) compared with capecitabine for all women, regardless of hormone status.