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Meta-Analysis
. 2016 Oct 14;11(10):e0164663.
doi: 10.1371/journal.pone.0164663. eCollection 2016.

Capecitabine in Combination with Standard (Neo)Adjuvant Regimens in Early Breast Cancer: Survival Outcome from a Meta-Analysis of Randomized Controlled Trials

Ze-Chun Zhang  1 , Qi-Ni Xu  2 , Sui-Ling Lin  3 , Xu-Yuan Li  4
Affiliations
Free PMC article
Meta-Analysis

Capecitabine in Combination with Standard (Neo)Adjuvant Regimens in Early Breast Cancer: Survival Outcome from a Meta-Analysis of Randomized Controlled Trials

Ze-Chun Zhang et al. PLoS One. .
Free PMC article

Abstract

Capecitabine has been investigated in early breast cancer in several studies, but it was undefined that whether it could improve survival. To investigate whether the addition of capecitabine affected survival in patients with early breast cancer, a meta-analysis was conducted and overall survival (OS), disease-free survival (DFS), and toxicity were assessed. The PubMed, Embase databases and the Cochrane Central Register of Controlled Trials were searched for studies between January 2006 and April 2016. Hazard ratios (HRs) with their 95% confidence intervals (CIs), or data for calculating HRs with 95% CI were derived. Seven trials with 9097 patients, consisted of 4 adjuvant and 3 neoadjuvant studies, were included in this meta-analysis. Adding capecitabine showed no improvement in DFS (HR = 0.93; 95% CI, 0.85-1.02; P = 0.12), whereas a significant improvement in OS was observed (HR = 0.85; 95% CI, 0.75-0.96; P = 0.008). A sub-analysis of DFS showed that benefit of capecitabine derived from patients with triple negative subtype and with extensive axillary involvement. Safety profiles were consistent with the known side-effects of capecitabine, but more patients discontinued scheduled treatment in the capecitabine group. Combining capecitabine with standard (neo)adjuvant regimens in early breast cancer demonstrated a significantly superior OS, and indicated DFS improvement in some subtypes with high risk of recurrence. Selection of subtypes was a key to identify patients who might gain survival benefit from capecitabine.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Results of search strategy.
Fig 2
Fig 2. Forest plot of disease-free survival of patients treated with capecitabine versus without capecitabine.
Fig 3
Fig 3. Forest plot of overall survival of patients treated with capecitabine versus without capecitabine.
Fig 4
Fig 4. Forest plot of disease-free survival of subgroup analysis in the adjuvant setting.
See this image and copyright information in PMC

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The authors received no specific funding for this work.