Capecitabine: Treatment options in metastatic breast cancer

Capecitabine (Xeloda®) is an orally administered chemotherapeutic agent, widely used for metastatic breast cancer treatment. Preclinical and clinical studies demonstrate selective enzymatic conversion of capecitabine into 5-fluorouracil, a potent cytotoxic agent within malignant tumors. Capecitabine is the only cytotoxic agent without cumulative toxicity and it exhibits synergistic activity when used in combination with a wide range of other cytotoxic and biologic agents. Capecitabine monotherapy results in an objective response rate of 15-37% in patients with metastatic breast cancer in the adjuvant setting. A combination regimen of capecitabine with docetaxel (Taxotere^®) improves overall survival in metastatic breast cancer compared with docetaxel monotherapy. Treatment-refractory, heavily pretreated and elderly patients have experienced positive outcomes with capecitabine, demonstrating its utility in diverse populations. Multiple trials suggest that initiating capecitabine treatment with lower daily doses may improve its safety and tolerability profile without compromising efficacy.