1
|
Holmes FA, Hellerstedt BA, Pippen JE, Vukelja SJ, Collea R, Kocs DM, Blum JL, McIntyre KJ, Barve MA, Brooks BD, Osborne CR, Wang Y, Asmar L, O'Shaughnessy J. Five-year results of a phase II trial of preoperative 5-fluorouracil, epirubicin, cyclophosphamide followed by docetaxel with capecitabine (wTX) (with trastuzumab in HER2-positive patients) for patients with stage II or III breast cancer. Cancer Med 2018; 7:2288-2298. [PMID: 29582557 PMCID: PMC6010779 DOI: 10.1002/cam4.1472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 02/18/2018] [Accepted: 02/26/2018] [Indexed: 01/04/2023] Open
Abstract
We aimed to increase pathologic complete response (pCR) in patients with invasive breast cancer by adding preoperative capecitabine to docetaxel following 5-fluorouracil, epirubicin, cyclophosphamide (FEC) (with trastuzumab for patients with HER2-positive disease) and to evaluate 5-year disease-free survival (DFS) associated with this preoperative regimen. Chemotherapy included four cycles of FEC100 (5-fluorouracil 500 mg/m2 , epirubicin 100 mg/m2 , cyclophosphamide 500 mg/m2 IV on Day 1 every 21 days) followed by 4 21-day cycles of docetaxel (35 mg/m2 days 1 and 8) concurrently with capecitabine (825 mg/m2 orally twice daily for 14 days followed by 7 days off) (wTX). For HER2-positive patients, treatment was modified by decreasing epirubicin to 75 mg/m2 and adding trastuzumab (H) in standard doses (FEC75-H →wTX-H). The study objective was to achieve a pCR rate in the breast and axillary lymph nodes of 37% in patients with HER2-negative breast cancer and of 67% in patients with HER2-positive breast cancer treated with preoperative trastuzumab. A total of 186 patients were enrolled on study. In an intent-to-treat analysis, the pCR rate was 31% (37/118, 95% CI: 24-40%) in the HER2-negative patients, 24% (15/62, 95% CI: 14-37%) in ER-positive/HER2-negative patients, 39% (22/56, 95% CI: 27-53%) in the ER-negative/HER2-negative patients, and 46% (29/63, 95% CI: 34-48%) in the HER2-positive patients. The pCR rate in the 40 trastuzumab-treated patients was 53% (21/40, 95% CI: 38-67%). Grade 3 and 4 adverse events included neutropenia, leukopenia, diarrhea, and hand-foot skin reactions. One trastuzumab-treated patient developed grade 3 cardiotoxicity, and 4 others experienced grade 1-2 decrements in left ventricular function; all five patients' cardiac function returned to their baseline upon completion of trastuzumab. At 5 years, disease-free survival was 70% in the HER2-negative population (78% in ER-positive/HER2-negative and 62% in the ER-negative/HER2-negative patients) and 80% in the HER2-positive patients (87% in the trastuzumab-treated HER2-positive patients). At 5 years, overall survival was 80% in the HER2-negative population (88% in ER-positive/HER2-negative and 71% in the ER-negative/HER2-negative patients) and 86% in the HER2-positive patients (94.5% in the trastuzumab-treated HER2-positive patients). FEC100 (FEC75 with trastuzumab) followed by weekly docetaxel plus capecitabine, with or without trastuzumab is a safe, effective preoperative cytotoxic regimen. However, the addition of capecitabine to docetaxel following FEC, with or without trastuzumab, did not increase pCR rates nor 5-year DFS over the rates that have been reported with standard preoperative doxorubicin/cyclophosphamide (AC) followed by paclitaxel, with or without trastuzumab. Therefore, the use of capecitabine as part of preoperative chemotherapy is not recommended.
Collapse
Affiliation(s)
- Frankie Ann Holmes
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas Oncology‐Houston Memorial CityHoustonTexas
| | - Beth A. Hellerstedt
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas Oncology‐Austin CentralAustinTexas
| | - John E. Pippen
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas Oncology‐Baylor Sammons Cancer CenterDallasTexas
| | - Svetislava J. Vukelja
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas OncologyTylerTexas
| | - Rufus P. Collea
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- New York Oncology HematologyAlbanyNew York
| | - Darren M. Kocs
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas OncologyRound RockTexas
| | - Joanne L. Blum
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas Oncology‐Baylor Sammons Cancer CenterDallasTexas
| | - Kristi J. McIntyre
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas OncologyDallas Presbyterian HospitalDallasTexas
| | - Minal A. Barve
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas OncologyDallas Presbyterian HospitalDallasTexas
| | - Barry D. Brooks
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas OncologyMedical City DallasDallasTexas
| | - Cynthia R. Osborne
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas Oncology‐Baylor Sammons Cancer CenterDallasTexas
| | - Yunfei Wang
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
| | - Lina Asmar
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
| | - Joyce O'Shaughnessy
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas Oncology‐Baylor Sammons Cancer CenterDallasTexas
| |
Collapse
|
2
|
O'Shaughnessy J, Koeppen H, Xiao Y, Lackner MR, Paul D, Stokoe C, Pippen J, Krekow L, Holmes FA, Vukelja S, Lindquist D, Sedlacek S, Rivera R, Brooks R, McIntyre K, Brownstein C, Hoersch S, Blum JL, Jones S. Patients with Slowly Proliferative Early Breast Cancer Have Low Five-Year Recurrence Rates in a Phase III Adjuvant Trial of Capecitabine. Clin Cancer Res 2015; 21:4305-11. [PMID: 26041745 DOI: 10.1158/1078-0432.ccr-15-0636] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/11/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE We conducted a randomized phase III study to determine whether patients with early breast cancer would benefit from the addition of capecitabine (X) to a standard regimen of doxorubicin (A) plus cyclophosphamide (C) followed by docetaxel (T). EXPERIMENTAL DESIGN Treatment comprised eight cycles of AC→T (T dose: 100 mg/m(2) on day 1) or AC→XT (X dose: 825 mg/m(2) twice daily, days 1-14; T dose: 75 mg/m(2) on day 1). The primary endpoint was 5-year disease-free survival (DFS). RESULTS Of 2,611 women, 1,304 were randomly assigned to receive AC→T and 1,307 to receive AC→XT. After a median follow-up of 5 years, the study failed to meet its primary endpoint [HR, 0.84; 95% confidence interval (CI), 0.67-1.05; P = 0.125]. A significant improvement in overall survival, a secondary endpoint, was seen with AC→XT versus AC→T (HR, 0.68; 95% CI, 0.51-0.92; P = 0.011). There were no unexpected adverse events. Of patients with estrogen receptor (ER)-positive/HER2-negative disease, 70% of whom were node-positive, 26% and 59% had tumors with a centrally assessed Ki-67 score of <10% or <20%, respectively, and only 17 (2%) and 53 (6%) DFS events, respectively, occurred in these groups at 7 years. CONCLUSIONS The very low event rate in patients with ER-positive, low Ki-67 cancers, regardless of nodal status, strongly suggests that these patients should not be enrolled in adjuvant trials that assess 5-year DFS rates and that central Ki-67 analyses can identify these patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | - John Pippen
- Texas Oncology Baylor-Sammons Cancer Center, US Oncology, Dallas, Texas
| | - Lea Krekow
- Texas Oncology-The Breast Care Center of North Texas, US Oncology, Bedford, Texas
| | | | | | | | | | - Ragene Rivera
- Texas Oncology-El Paso Cancer Treatment Center, US Oncology, El Paso, Texas
| | - Robert Brooks
- Arizona Oncology Associates, US Oncology, Tucson, Arizona
| | - Kristi McIntyre
- Texas Oncology-Dallas Presbyterian Hospital, US Oncology, Dallas, Texas
| | | | | | - Joanne L Blum
- Texas Oncology Baylor-Sammons Cancer Center, US Oncology, Dallas, Texas
| | | |
Collapse
|
3
|
Fan Y, Xu BH, Yuan P, Ma F, Wang JY, Ding XY, Zhang P, Li Q, Cai RG. Docetaxel-cisplatin might be superior to docetaxel-capecitabine in the first-line treatment of metastatic triple-negative breast cancer. Ann Oncol 2012; 24:1219-25. [PMID: 23223332 DOI: 10.1093/annonc/mds603] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) may be more sensitive to platinum. This study was to compare platinum-based regimen with nonplatinum regimen in the first-line treatment of advanced TNBC. PATIENTS AND METHODS Eligible metastatic TNBC (mTNBC) women without prior treatment for advanced disease were randomized (1 : 1) to receive either docetaxel-cisplatin (TP) or docetaxel -capecitabine (TX) q3w for up to 6 cycles, until disease progression or unacceptable toxicity. The primary end point was objective response rate (ORR) and the secondary end points included progression-free survival (PFS) and overall survival (OS). In total 53 patients were enrolled. RESULTS The median follow-up was 24 months. ORR was higher in the TP group than in the TX group (63.0% versus 15.4%, P = 0.001). PFS was more than doubled (10.9 months versus 4.8 months, P < 0.001) and median OS was also greatly improved (32.8 months versus 21.5 months, P = 0.027). Toxic effects were not different except G3/4 vomiting and G2/3 hand-foot syndrome. CONCLUSIONS This study suggested that cisplatin-based chemotherapy was superior to capecitabine-based regimen in the first-line treatment of mTNBC, as measured by ORR, PFS and OS. Further large-scale study should be warranted. These results are not sufficient to change clinical practice.
Collapse
Affiliation(s)
- Y Fan
- Department of Medical Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Blum JL, Barrios CH, Feldman N, Verma S, McKenna EF, Lee LF, Scotto N, Gralow J. Pooled analysis of individual patient data from capecitabine monotherapy clinical trials in locally advanced or metastatic breast cancer. Breast Cancer Res Treat 2012; 136:777-88. [PMID: 23104222 DOI: 10.1007/s10549-012-2288-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 10/03/2012] [Indexed: 11/29/2022]
Abstract
We assessed the efficacy and safety of capecitabine across treatment lines, and the impact of patient and disease characteristics on outcomes using data from phase II/III trials. Individual patient data were pooled from seven Roche/Genentech-led trials conducted from 1996 to 2008 where single-agent capecitabine was the test or control regimen for metastatic breast cancer (MBC). Data were analyzed from 805 patients: 268 in the first-line metastatic setting and 537 in the second-line or later setting. Baseline characteristics were balanced across treatment lines. Patients receiving second-line or later versus first-line capecitabine had lower objective response rates (ORR: 19.0 vs. 25.0 %, respectively, odds ratio 0.70; 95 % CI: 0.5-1.0) and significantly shorter progression-free survival (PFS: median 112.0 days [3.7 months] vs. 150.0 days [4.9 months]; p < 0.0001) and overall survival (OS: median 396.0 days [13.0 months] vs. 666.0 days [21.9 months]; p < 0.0001). In multivariate analysis by backward elimination, significantly improved ORR (p = 0.0036), PFS (p < 0.0001) and OS (p < 0.0001) with capecitabine were demonstrated in patients with estrogen receptor (ER) and/or progesterone receptor (PgR)-positive versus both ER and PgR-negative tumors. Hand-foot syndrome (HFS) was the most common adverse event (AE) in 63 % of patients. Overall, 7 % of patients discontinued and two patients (<1 %) died from treatment-related AEs. Significantly improved survival was observed in patients developing capecitabine-related HFS (p < 0.0001 PFS/OS) or diarrhea (p = 0.004 OS; p = 0.0045 PFS) versus patients without these events. In this pooled analysis of individual patient data, first-line capecitabine was associated with improved ORR, PFS, and OS versus second or later lines. Multivariate analyses identified greater ORR, PFS, and OS with capecitabine in patients with ER and/or PgR-positive versus ER/PgR-negative tumors. Safety was in-line with previous phase III trials in MBC.
Collapse
Affiliation(s)
- Joanne L Blum
- Baylor-Charles A. Sammons Cancer Center, Texas Oncology, US Oncology, 3410 Worth Street, Suite 400, Dallas, TX 75246, USA.
| | | | | | | | | | | | | | | |
Collapse
|