Concurrent Use of Capecitabine With Radiation Therapy and Survival in Breast Cancer (BC) After Neoadjuvant Chemotherapy

Clin Transl Oncol. 2018 Oct;20(10):1280-1288. doi: 10.1007/s12094-018-1859-7. Epub 2018 Mar 28.

Abstract

Purpose: Capecitabine has been studied as a radiosensitizer, and our study seeks to examine the association of concurrent capecitabine/radiation therapy (RT) on event-free- (EFS) and overall survival (OS) in women with breast cancer (BC) with residual disease after neoadjuvant chemotherapy (NAC).

Methods/patients: In a retrospective study of women with BC who received adriamycin/taxane-based NAC from 2004-2016, we identified 21 women administered concurrent capecitabine/RT. To assess differences in survival, we selected a clinical control cohort (n = 57) based on criteria used to select patients for capecitabine/RT. We also created a matched cohort (2:1), matching on tumor subtype, pathological stage and age (< 50 or 50+ years). Differences in EFS, using STEEP criteria, and OS, using all-cause mortality, between those who received capecitabine/RT and controls were assessed.

Results: Of the 21 women who received capecitabine/RT, median age was 52 years. The majority were pathologic stage III (n = 15) and hormone receptor-positive/HER2-negative BC (n = 20). In those receiving capecitabine/RT, there were 9 events, compared with 14 events in clinical and 10 events in matched controls. Capecitabine/RT was associated with worse OS in clinical (HR 3.83 95% CI 1.12-13.11, p = 0.03) and matched controls (HR 3.71 95% CI 1.04-13.18, p = 0.04), after adjusting for clinical size, pathological stage and lymphovascular invasion. Capecitabine/RT was also associated with a trend towards worse EFS in clinical (HR 2.41 95% CI 0.86-6.74, p = 0.09) and matched controls (HR 2.68 95% CI 0.91-7.90, p = 0.07) after adjustment.

Conclusion: Concurrent capecitabine/RT after NAC is associated with worse survival and should be carefully considered in BC.

Keywords: Breast cancer; Capecitabine; Neoadjuvant chemotherapy; Radiation; Survival.

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / mortality
  • Breast Neoplasms / radiotherapy*
  • Capecitabine / administration & dosage
  • Chemoradiotherapy, Adjuvant / methods*
  • Chemoradiotherapy, Adjuvant / mortality
  • Disease-Free Survival
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Middle Aged
  • Neoadjuvant Therapy / methods
  • Proportional Hazards Models
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Capecitabine