Capecitabine as salvage treatment in relapsed nasopharyngeal carcinoma: a phase II study

PURPOSE

To evaluate the efficacy of capecitabine (Xeloda) as rescue treatment (2nd, 3rd and 4th line) in patients with relapsed nasopharyngeal carcinoma (NPC) in a phase II study.

PATIENTS AND METHODS

Between 5/2002-11/2005, 23 relapsed NPC patients (17 locoregional relapse, 3 metastatic, 3 locoregional + metastatic) received capecitabine 2500 mg/m(2)/d, days 1-14 every 3 weeks, until progression or for a maximum of 6 cycles.

PATIENT CHARACTERISTICS

23 patients (14 men, 9 women) with median age 46 years (range 15-59); ECOG performance status 1 n=21, 2 n=2; histology: undifferentiated carcinoma (WHO type III) n=21, non-keratinizing epidermoid carcinoma (WHO type II), n=2. Capecitabine was given as 2nd--(13 patients), 3rd--(7 patients), and 4th--(3 patients) line chemotherapy. Previous chemotherapy regimes were epirubicin + cisplatin, paclitaxel + carboplatin, paclitaxel + 5-fluorouracil and leucovorin (5-FU/LV) or methotrexate. 104 cycles were given (median 5, range 2-6). Two (9%) patients achieved complete response (CR); 9 (39%) partial response (PR); 9 (39%) stable disease (SD) and 3 (13%) progressed (PD). Toxicity was mild without toxic deaths or grade 4 toxicities. The most frequent toxicities (grades 1-3) were anemia (38%), hand-foot syndrome (23%), leukopenia (13%) and diarrhea (7%). Median follow-up was 10 months (range 2-44). Median overall survival was not reached at 18 months and actuarial one-year survival was 62% (95% confidence interval/CI: 41-80). Median progression-free survival was 14 months.

CONCLUSION

Capecitabine is active in relapsed NPC patients, achieving 48% objective responses, with mild toxicity. It is an attractive therapy to be administered in an outpatient setting.

Updated results from a phase II study of sequential treatment epirubicin, cyclophosphamide (EC), surgery and docetaxel (DTX) in stage II and III breast cancer

11096

Background: The study was designed to evaluate the efficacy and safety of sequential administration of epirubicin plus cyclophosphamide (EC) followed by surgery and docetaxel (DTX). Methods: All patients (74) with untreated breast cancer stage II and III received epirubicin (E) 100mg/m2 given in 30 min followed by cyclophosphamide (C) 600mg/m2(q3w).After four cycles of neoadjuvant chemotherapy, the pts were evaluated for response: 46 ( 62.1%) presented PR, 2 (2.7%) CR and 26 ( 35.2%) SD and then they underwent surgery: conservative (17.57%) or radical mastectomy (82.43%).After surgery, the patients received four cycles of docetaxel (DOC) 100mg/m2 (1 hour , q3w). The median age was 46 ( 24–66) years, with 51 ( 69%) premenopausal and 23 (31%) postmenopausal patients. Results: The pathological response was pT1 lower to 2 cm, 41 patients ( 55.41%), pT 2–5 cm, 33 pts ( 44. 59%); pN+ 1–3: 13 pts ( 17.56%); pN+ = 4 and more than four: 61 pts ( 82.44%). Overall survival at 60 months was 59. 57% and DFS was 41.25%. For patients with pN+1–3 , at 5 years DFS was 46.35% and for those with pN+ = 4 and more 4, DFS was 38.25% (p=0.045).Overall survival at 5 years follow-up was 65.74% for pts with pN+ 1–3 and 57.36% for those with pN+=4 and more than 4. Conclusions: Previous interim analysis results of sequential chemotherapy with DTX demonstrate the efficacy and safety of these treatment in breast cancer stage II and III. At 5 years follow-up, we conclude that the use of four cycles of EC followed by sugery and then four cycles of DTX is a reasonable treatment choice for at least some patients with breast cancer st II and III.

No significant financial relationships to disclose.

Capecitabine (Xeloda) and quality of life (QoL) in patients (pts) with metastatic breast cancer (MBC) relapsing after treatment with anthracycline and taxane containing–therapy

10774

Background: The study was designed to evaluate further the efficacy and safety of capecitabine in patients with MBC previously treated with antracycline and taxane. In addition to response rates and survival times, pts preference for oral therapy and QoL are increasingly important considerations in MBC. Methods: All MBC patients had to have documented progression after antracycline and taxane- containing chemotherapy in neoadjuvant or adjuvant setting, no more than one line for MBC. Treatement comprised 3-week cycles of oral capecitabine 1250 mg/m2 twice- daily for 14 days followed by a 7-day rest period. Results: From December 2002 to November 2005, 35 pts were enrolled. Baseline characteristics of the pts. were: median age 51 years (range 33–73), median ECOG PS 1 (range 0–2) and adequate bone marrow, renal and hepatic functions. Median number of metastatic sites was 2 (range 1–5). The pts were evaluable for response and toxicity and received a total of 162 cycles of chemotherapy. Disease stabilization occurred in 11 pts (31.4%), the overall response was 34.2%, ten pts (28.5%) achieved a partial response, two patients (5.7%) achieved a complete response. Median duration of response was 5 months and median overall survival was 8 months with significant advantage for responding patients. For pts achieving a CR or PR, median survival was 13 months, for SD 10 months and for pts with PD as best response 5 months. The most treatment-related adverse events were grade 1/2 in intensity: grade 3 treatment-related adverse events were hand-foot syndrome (11%), diarrhea (7%), vomiting (5%), and nausea (6%). Pts had a significant, sustained improvement in the following: global health status, role and emotional functioning, social functioning, breast symptoms, arm symptoms and hair loss. Conclusions: This study confirms that capecitabine achieves a high tumor control rate in heavily pretreated MBC pts. Pts had a significant improvement in global health status, with substantial improvements in almost all functional and symptomatic QoL domains. Capecitabine should be considered the reference treatment in this setting based on consistently high efficacy and good tolerability.

No significant financial relationships to disclose.