Single-agent vs combination therapy in advanced breast cancer: potential roles of capecitabine

Available data on the use of active chemotherapy agents in advanced breast cancer suggest that sequential single-agent therapy is associated with outcomes similar to those achieved with concurrent combination therapy. Since the use of single agents is likely to be associated with reduced toxicity and may be associated with improved quality of life, this approach should be strongly considered when assessing treatment options. Capecitabine (Xeloda) is an effective agent in advanced breast cancer, with a recent phase III trial demonstrating significant advantages of capecitabine/docetaxel (Taxotere) over single-agent docetaxel in response rate, time to disease progression, and overall survival in anthracycline-pretreated patients. Analysis of survival based on poststudy chemotherapy showed a significant survival benefit in a relatively small group of single-agent docetaxel patients who subsequently received capecitabine compared with all other poststudy chemotherapy, suggesting the potential for marked benefits with sequential treatment. On the basis of data demonstrating the effectiveness of single-agent capecitabine, a trial has been initiated to compare single-agent capecitabine with standard combination adjuvant therapy in elderly high-risk patients.