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Azim HA, Saleh MA, Essam Eldin P, Abdelhafeez AAM, Hassan M, Kassem L. Combination of metronomic capecitabine and letrozole in metastatic hormone receptor positive, HER2 negative breast cancer: a randomized phase II trial. J Chemother 2024:1-9. [PMID: 38764430 DOI: 10.1080/1120009x.2024.2342741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/09/2024] [Indexed: 05/21/2024]
Abstract
First line endocrine therapy is the gold standard for advanced estrogen receptor positive, human epidermal growth factor receptor 2 negative breast cancer. Adding CDK4/6 inhibitors has improved progression free survival. Metronomic Capecitabine has proven to be safe to combine with endocrine therapy with promising efficacy. We conducted a phase II randomized, open label, single centre clinical trial on patients with metastatic ER positive and HER 2 negative breast cancer. Eligible patients were randomized (1:1) to arm A: metronomic dose of capecitabine (500 mg/m2 BID) combined with letrozole (2.5 mg OD) or arm B: letrozole single agent. The primary endpoint was progression free survival. The study was terminated early due to poor accrual and 60 eligible patients out of the planned 204 were randomized. This clinical trial is registered on ClinicalTrials.gov (MD-127-2019, NCT04571437). Between February 2019 and April 2022, 60 patients were randomized. This is the first report of the study, after a median follow-up of 18.6 months. The median age at diagnosis was 47 years with only 41.7% of patients post-menopausal. Half of our patients had bone-only disease, 45% had visceral metastasis (liver and lung) and 63% presented with endocrine sensitive disease. The estimated median PFS for the whole population was 16.2 months. Median PFS for capecitabine arm was 17.7 months versus 14.6 months for letrozole alone (p = 0.078). Overall response rate was 70% for capecitabine/letrozole arm and 56.6% for letrozole only. Clinical benefit rate was 90% in the capecitabine/letrozole arm versus 73.3% in the letrozole arm. Overall survival data is still immature after this short follow up duration. Adverse event assessment showed acceptable all grade and high grade toxicity profile consistent with the established adverse events of both capecitabine and letrozole. Anaemia (28.3%) and hand & foot syndrome (43.8%) were significantly more common in the capecitabine/letrozole arm. Capecitabine combined with letrozole have showed a trend towards improvement in progression free survival with potential more benefit to certain sub-groups and the combination showed acceptable safety profile consistent with the established known safety profile of both letrozole and capecitabine.
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Affiliation(s)
- Hamdy A Azim
- Clinical Oncology Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mariam A Saleh
- Clinical Oncology Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Passant Essam Eldin
- Anatomic Pathology Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed A M Abdelhafeez
- Clinical Oncology Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Hassan
- Clinical Oncology Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Loay Kassem
- Clinical Oncology Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
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Alvarado-Miranda A, Lara-Medina FU, Muñoz-Montaño WR, Zinser-Sierra JW, Galeana PAC, Garza CV, Sanchez Benitez D, Limón Rodríguez JA, Arce Salinas CH, Guijosa A, Arrieta O. Capecitabine Plus Aromatase Inhibitor as First Line Therapy for Hormone Receptor Positive, HER2 Negative Metastatic Breast Cancer. Curr Oncol 2023; 30:6097-6110. [PMID: 37504314 PMCID: PMC10377785 DOI: 10.3390/curroncol30070454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/29/2023] Open
Abstract
(1) Background: recent evidence suggests that long low-dose capecitabine regimens have a synergistic effect with endocrine therapy as aromatase inhibitors (AIs), and might increase overall survival for hormone-receptor-positive, HER2-negative, metastatic breast cancer compared to both treatments. We performed a retrospective study to confirm the efficacy and expand the safety data for capecitabine plus AI (a combination henceforth named XELIA) for this indication. (2) We conducted a single-center retrospective cohort study of 163 hormone receptor-positive metastatic breast cancer patients who received either the XELIA regimen, capecitabine, or an aromatase inhibitor (AI) as single agents in first-line treatment. The primary endpoint was progression-free survival, and the secondary endpoints were overall survival, best objective response, and toxicity incidence. (3) Results: the median progression-free survival for patients receiving XELIA, AI, and capecitabine was 29.37 months (20.91 to 37.84; 95% CI), 20.04 months (7.29 to 32.80; 95% CI) and 10.48 (8.69 to 12.28; 95% CI), respectively. The overall response rate was higher in the XELIA group (29.5%) than in the AI (14.3%) and capecitabine (9.1%) groups. However, the differences in overall survival were not statistically significant. Apart from hand-foot syndrome, there were no statistically significant differences in adverse events between the groups. (4) Conclusions: this retrospective study suggests that progression-free survival and overall response rates improved with the XELIA regimen compared to use of aromatase inhibitors and capecitabine alone. Combined use demonstrated an adequate safety profile and might represent an advantageous treatment in places where CDK 4/6 is not available. Larger studies and randomized clinical trials are required to confirm the effects shown in our study.
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Affiliation(s)
| | | | | | - Juan W Zinser-Sierra
- Gastrointestinal Oncology Unit, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | | | - Cynthia Villarreal Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnológico de Monterrey, San Pedro Garza García 66278, Mexico
| | | | | | | | - Alberto Guijosa
- School of Medicine, Universidad Panamericana, Mexico City 03920, Mexico
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
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3
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Caparica R, De Angelis C, Fêde Â, Werutsky G, de Azambuja E. Metronomic chemotherapy combined with endocrine therapy: are we challenging some dogmas? Expert Rev Anticancer Ther 2020; 20:563-573. [PMID: 32536212 DOI: 10.1080/14737140.2020.1782200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Metronomic chemotherapy exerts its effects via inhibition of angiogenesis, immune modulation of the tumoral stroma, induction of senescence and apoptosis of tumor cells. Due to its favorable toxicity profile and its oral administration, metronomic chemotherapy arises as a promising alternative to be combined with endocrine therapy for the treatment of patients with luminal breast cancer. AREAS COVERED The present manuscript reviews the rationale supporting the combination of metronomic chemotherapy and endocrine therapy, discussing the studies that evaluated this regimen in the treatment of early-stage and metastatic breast cancer patients. Finally, we conclude by providing an expert opinion on the current role and perspectives for the combination of metronomic chemotherapy and endocrine therapy in the management of patients with luminal breast cancer. EXPERT OPINION Retrospective series and early-phase clinical trials have shown promising signs of activity and a favorable toxicity profile with this regimen, which warrants further investigation as a treatment option for luminal breast cancer patients.
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Affiliation(s)
- Rafael Caparica
- Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.) , Brussels, Belgium
| | - Claudia De Angelis
- Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.) , Brussels, Belgium.,Unit of Medical Oncology 2, Azienda Ospedaliera-Universitaria Pisana , Pisa, Italy
| | - Ângelo Fêde
- Medical Oncology department, AC Camargo Cancer Center , Sao Paulo, Brazil
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG) , Porto Alegre, Brazil
| | - Evandro de Azambuja
- Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.) , Brussels, Belgium
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Rashad N, Abdelhamid T, Shouman SA, Nassar H, Omran MA, El Desouky ED, Khaled H. Capecitabine-Based Chemoendocrine Combination as First-Line Treatment for Metastatic Hormone-Positive Metastatic Breast Cancer: Phase 2 Study. Clin Breast Cancer 2020; 20:228-237. [PMID: 32005499 DOI: 10.1016/j.clbc.2019.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/21/2019] [Accepted: 12/31/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Preclinical studies have suggested a synergistic effect of tamoxifen and capecitabine in estrogen receptor-positive cell lines. We evaluated the safety and efficacy of first-line chemoendocrine treatment in patients with metastatic breast cancer. Biochemical assessment was performed of serum levels of thymidine phosphorylase enzyme (TP), serum tamoxifen, hydroxytamoxifen, and 5-fluorouracil in relationship to efficacy. PATIENTS AND METHODS This prospective phase 2 interventional study studied patients with estrogen receptor-positive, HER2- metastatic breast cancer who received either tamoxifen/capecitabine or letrozole/capecitabine as first-line treatment. The dose of capecitabine provided at 2000 mg per day continuously as a fixed dose. RESULTS Forty women with a median age of 49.3 years were enrolled. For the whole study group, median progression-free survival (PFS) was 10 months and median overall survival (OS) was 23.3 months. The overall response rate was 60% and the clinical benefit rate 82.5%. Progesterone receptor positivity was associated with significantly longer PFS (12 vs. 7 months, P = .021). The most frequent adverse events were palmar-plantar erythrodysesthesia (62.5%), fatigue (62.5%), diarrhea (30%), abdominal pain (12.5%), and constipation (10%). Changes in serum level of TP were not correlated to response to treatment, PFS, or OS. Higher serum levels of tamoxifen and hydroxytamoxifen were correlated with higher response rates and longer PFS but not OS. CONCLUSION Chemoendocrine treatment is well tolerated, with no evidence of contradictory effects between the combination components. However, the efficacy data need more validation.
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MESH Headings
- Abdominal Pain/chemically induced
- Abdominal Pain/epidemiology
- Adult
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/adverse effects
- Antineoplastic Agents, Hormonal/administration & dosage
- Antineoplastic Agents, Hormonal/adverse effects
- Antineoplastic Agents, Hormonal/pharmacokinetics
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/pharmacokinetics
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/blood
- Breast Neoplasms/drug therapy
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Capecitabine/administration & dosage
- Capecitabine/adverse effects
- Capecitabine/pharmacokinetics
- Constipation/chemically induced
- Constipation/epidemiology
- Diarrhea/chemically induced
- Diarrhea/epidemiology
- Female
- Hand-Foot Syndrome/epidemiology
- Hand-Foot Syndrome/etiology
- Humans
- Letrozole/administration & dosage
- Letrozole/adverse effects
- Letrozole/pharmacokinetics
- Middle Aged
- Progression-Free Survival
- Prospective Studies
- Receptor, ErbB-2/analysis
- Receptors, Estrogen/analysis
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/analysis
- Receptors, Progesterone/metabolism
- Tamoxifen/administration & dosage
- Tamoxifen/adverse effects
- Tamoxifen/pharmacokinetics
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Affiliation(s)
- Noha Rashad
- Department of Medical Oncology, Maadi Armed Forces Hospital, Cairo, Egypt.
| | - Thoraya Abdelhamid
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Samia A Shouman
- Pharmacology Unit, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hanan Nassar
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mervat A Omran
- Pharmacology Unit, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Eman D El Desouky
- Department of Biostatistics and Epidemiology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hussein Khaled
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
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Abdelmaksoud BA, Toam MM, Fayed AA. Metronomic capecitabine with aromatase inhibitors for patients with metastatic hormone-receptor positive, HER2-negative breast cancer. BREAST CANCER MANAGEMENT 2019. [DOI: 10.2217/bmt-2019-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: To evaluate the efficacy and safety of combined metronomic capecitabine with aromatase inhibitors (AIs) for patients with newly diagnosed metastatic hormone-receptor positive, HER2-negative breast cancer. Patients & methods: A total of 41 women with a diagnosis of metastatic hormone-receptor positive, HER2-negative breast cancer received oral metronomic capecitabine, 500 mg/m2 twice daily combined with an AI. Results: After a median follow-up of 24 months (9–50), a median of 15 months of treatment were completed, the median time to progression was 15 months (12.6–17.3) and the median overall survival was 37 months (23.6–50.4). The treatment was tolerated with less than 10% grade 3 toxicities. Conclusion: Combination of metronomic capecitabine and AIs appears to be safe and has encouraging results in advanced hormone-receptor positive, HER2-negative breast cancer.
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Affiliation(s)
- Bader A Abdelmaksoud
- Department of Clinical Oncology & Nuclear Medicine, Faculty of Medicine, Zagazig University, Elgamaa st 44519, Zagazig, Egypt
| | - Mostafa M Toam
- Department of Clinical Oncology & Nuclear Medicine, Faculty of Medicine, Zagazig University, Elgamaa st 44519, Zagazig, Egypt
| | - Alaa A Fayed
- Department of Clinical Oncology & Nuclear Medicine, Faculty of Medicine, Zagazig University, Elgamaa st 44519, Zagazig, Egypt
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Shankar A, Thakur R, Meshram N, Keditsu K, Srinivas P. NCI Summer Curriculum in Cancer Control and Prevention – A Practice Changing Course for Oncologists from Limited
Resource Country Like India. Asian Pac J Cancer Prev 2018; 19:1157-1160. [PMID: 29801394 PMCID: PMC6031832 DOI: 10.22034/apjcp.2018.19.5.1157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Cancer has become an important public health issue in India. Oncologists in India spends most of their time in
diagnosis and treatment of cancer patients. There is a large disparity geographically as far as cancer treatment facilities
are concerned. Cancer control and cancer prevention is not a point of concern for most of the practicing oncologist.
Although things are changing in India, but orientation, passion and dedication towards cancer prevention is still missing.
There is no program on basic principles and practice of cancer control and prevention in India which addresses the
essence of cancer control and prevention. Center for Global Health of National Cancer Institute, USA initiated summer
curriculum is an excellent academic program to teach health care professionals working in cancer care in different parts
of world. This covers all aspect of cancer care i.e. cancer education, epidemiology, screening, diagnosis, treatment
and the before world palliative care with dedicated session on upcoming molecular prevention in cancer. This gives
an unique opportunity for learning and can be practice changing curriculum for many of the attendees who want to
pursue a career in cancer control and prevention a before practice.
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Affiliation(s)
- Abhishek Shankar
- Department of Preventive oncology, Dr B R Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India.
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Shankar A, Roy S, Rath GK, Chakraborty A, Kamal VK, Biswas AS. Impact of Cancer Awareness Drive on Generating Understanding and Improving Screening Practices for Breast Cancer: a Study on College Teachers in India. Asian Pac J Cancer Prev 2017; 18:1985-1990. [PMID: 28749636 PMCID: PMC5648409 DOI: 10.22034/apjcp.2017.18.7.1985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Breast cancer is the most common cancer among women in India and most present at advanced stage. Although early detection is the only way to reduce morbidity and mortality, people have a very low awareness about breast cancer signs and symptoms and screening practices. The purpose of this study was to assess the level of awareness and impact of awareness programs in adoption of safe practices in prevention and early detection. Methods: This assessment was part of a pink chain campaign on cancer awareness. During events from 2011 to 2015 at various women colleges in different parts in India, a pre-test of knowledge related to breast cancer was followed by an awareness program. Post-tests using the same questionnaire were conducted at the end of the interactive sessions, at 6 months and after1 year. Results: A total of 872 out of 985 teachers participated in the study (overall response rate of 88.5 %). Mean age of the study population was 41.6 years (range 28-59 yrs). There was a significant increase in level of knowledge regarding breast cancer at 6 months and this was sustained at 1 year. Adoption of breast self-examination (BSE) was significantly more frequent in comparison to CBE and mammography. Magazines and newspapers were sources for knowledge regarding screening tests for breast cancer for more than 60% of teachers. Regarding post-awareness at 6 months and 1 year, there was a significant change in alcohol and smoking habits. Major reasons came out to be ignorance (83%) at the start of the campaign which was changed to lack of time (37.7%), lethargic attitude (32.2 %) and lack of time (31.5 %) at 6 months and same at 1 year also. Conclusions: With our awareness program there was a significant increase in level of knowledge regarding breast cancer at 6 months and this was sustained at 1 year. Adoption of BSE was significantly greater in comparison to CBE, mammography. To inculcate safe lifestyle practices in people, awareness programmes such as pink chain campaigns should be conducted more widely and frequently.
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Affiliation(s)
- Abhishek Shankar
- Department of Preventive Oncology, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), Delhi, India.
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