1. DR VANDERPUYE CONSULTANT RADIATION AND CLINICAL ONCOLOGIST GHANA
REVIEW 0F 20 METASTATIC BREAST CANCER CASES RECEIVING CAPECITABINE MONOTHERAPY
DR VANDERPUYE
CONSULTANT RADIATION AND CLINICAL ONCOLOGIST
GHANA

2. PURPOSE
TO EVALUATE THE TIME TO PROGRESSION AND TOXICITY OF TWENTY STAGE 4 BREAST CANCER PATIENTS TREATED WITH CAPECITABINE MONOTHERAPY IN GHANA

3. Introduction 20- 85% of breast cancer patient→mets in 5 yrs
6- 10% will be diagnosed initially as stage 4
MS of stage 4 is mths traditionally
New drugs/ targeted developments →↑ OS
QoL is prime consideration in palliative care
Even though combination therapy may ↑TTP, RR, but ↑toxicity with little ↑OS benefit
International guidelines recommend single agent chemotherapy as a viable option
Best combination ≠ best outcome all things considered

4. Introduction Even for CR response last 8- 14 mths
Overall average TTP is 7 months with chemo
Remember progression is inevitable
Drugs used as 2ND line are tax, gem, cape, vinorelbine, anthracylines etc
Xeloda with other drugs ↑benefits no doubt
Comparatively cape citabine monotherapy ↓ lowest toxicity even at reduced doses
For low resource setting finance is #1!!
Creating the fine balance b/n QoL & outcome can be problematic!!

5. MATERIALS AND METHODS
20 Patients diagnosed With Metastatic Breast Cancer
PS ECOG < 3
Patients With No Prior Chemotherapy Were NOT Allowed
All Had Capecitabine As Monotherapy In Metastatic State
Parameters Assessed Include
Age
Initial Chemotherapy
Site Of Recurrence
Dose Of Capecitabine
Toxicity
Time To Progression

6. RESULTS Age Range : 25 – 84 Yrs Median Age: 46yrs
Followup Range: 1 – 40 Mths
Median Followup: 6 Mths
Mean Followup Time: 20mths
# Sites Involved
1 Site (9)
2 Sites (7)
>2 Sites ( 4)

7. RESULTS CAPECITABINE PER LINE OF TX Prior Chemotherapy:
Adjuvant Anthracycline 12
Taxane/Anth 3
2nd Line Taxane
Dose Of Capecitabine:
mg/M2
2000mg/M2
# Of Capecitabine Cycles: 3-18
Mean # Cycles: 6
3/20 Dose Reductions After ≥4cycles
(2 @ 2500mg/M2)

8. RESULTS Time To Progression(TTP) Range: 3 – 44 Months
Median Overall TTP: 6 Mths
Median TTP For Brain (X Only) :4mths ( 4- 9mths)
Median TTP For Brain (X +Rt) :24mths (4- 38 Mths)
Median TTP Per Line Of Tx
2nd Line :11 Mths ( 3 – 27mths)
3rd Line : 6 Mths ( 3- 10mths)
4th Line : 5 Mths ( 3- 7mths)

9. TOXICITY PROFILE Diarrhoea & vomiting Hand & Foot Haematological
Diarrhoea & vomiting
Hand & Foot
Haematological
Mucositis
Grade 1 1
Grade 2
Grade 3
Grade 4

10. DISCUSSION Literature summary of RR of single agents
Docetaxel % % Febrile Neutropenia!
Vinorelbine 25% % G 3/4 Neutropenia
Gemcitabine 0% Myelosupression
Capecitabine 20% H&F , D&V
2500mg/m2⇒ D & V Interruptions(56%)
↑G 3 H&f (30%)
⇒Stop!( 17%)
2000mg/ m2 ⇨ more tolerable
less H&F
less interruptions

11. DISCUSSION
Compared to other single agents , toxicity very manageable especially at lower than recommended doses supported by numerous data(>8) without compromising outcome
Fewer dose reductions/ interruptions with 2000mg/m2
Oral adminstration a big plus for QOL,
patient
resources ie adjuvants, staffing,
Even as 2, 3 th line acceptable alternative
Best results in TTP when with RT for brain mets!
Temozolamide with RT the only recommended choice but maybe a new paradigm

12. DISCUSSION Monotherapy Capecitabine TTP 4.2 MTHS
When given as combination
What does 2 mths benefit mean to US?
( toxicity, finances)
No compelling evidence that combination tx better
Combination
TTP ( MTHS)
X + CISPLATIN
6.3
X + DOCETAXEL
6.1
X + IXAPETHILONE
5.8
X+ BEVICUCIMAB
4.0

13. CONCLUSION Recommend Capecitabine for metastatic breast ca
In low resource setting as mono- or combination tx
Prefarably for taxane and anthracycline resistant but taxane not readily available
Can be used as 2nd , 3rd or more
without compromise and reduces cost.
Further investigation for brain RT+ capecitabine!!

14. References
1.JL Blum et al JCO VOL 17:2, 1999; ES Thomas et al JCO 2008 MAY : 26(13); NCCN VERSION , METASTASTATIC BREAST CANCER 4. Carrick S et al Cochrane Database of systemic Reviews Cardosa F Annals of Oncology 2008 :13: Brinker H Acta Oncol 1988; 27: Norton L N Eng J Med 1991; ASCO Quality Adjusted JCO 1996:14; O’Shaughnessy et al J JCO 2002 Jun 15: 20(12): O’Shaughnessy J The Oncologist vol 10 0ct 2005; Seidman A D et al The Oncologist vol 7 , suppl 6, Dec Oksuzoglu B et al Chemotherapy 2008: 54(5); O’Shaughnessy J et al The oncologist vol 13; Hennessy BT Annals of Oncol (8): pg O’Shaughnessy J et al Annals of Oncol 2001;12; Talbot DC et al B J Cancer 2002; 86: Cassidy J et al Annals of Oncol 2002: 13; Hoff PM et al JCO 2001 :19: Blum J et al Eur J Cancer 2001;37(suppl 6);S190a