Optimizing the management of HER2-negative metastatic breast cancer with capecitabine (Xeloda)

Patients with metastatic breast cancer (MBC) require chemotherapy that improves outcomes without compromising quality of life. To achieve optimal outcomes with chemotherapy, treatment choices should be influenced by patient and disease characteristics, as well as patient preferences. Capecitabine (Xeloda; F. Hoffmann-La Roche, Basel, Switzerland) combined with docetaxel achieves significantly superior response rates, time to progression, and overall survival compared with single-agent docetaxel. With a manageable safety profile, capecitabine/docetaxel is a particularly appropriate option for younger, fitter patients with rapidly progressing disease and/or visceral metastases. In addition, studies show that dosing flexibility with capecitabine/docetaxel allows management of side effects without compromising efficacy. However, for older patients and those with comorbidities or more indolent disease, single-agent capecitabine may be more appropriate. Studies show that front-line capecitabine is a highly effective and well-tolerated alternative to standard intravenous treatments. The activity of capecitabine in the first-line treatment of MBC is underpinned by its consistently high activity in MBC. As an oral agent that causes minimal alopecia and myelosuppression, capecitabine has the potential to significantly improve patient quality of life and convenience. In summary, the treatment of MBC will always need to be individualized, but a large body of evidence indicates that capecitabine, whether alone or in combination, can be offered to women early in the disease course.