Capecitabine (trade name Xeloda) is an oral chemotherapeutic agent used to treat breast cancer, gastric cancer, and colorectal cancer. It is actually a prodrug that is metabolized to fluorouracil, an antimetabolite that impedes the growth of cells. The enzyme that converts the prodrug form into fluorouracil is present in higher concentrations in neoplastic (cancer) cells, making it more active in these cells than in normal cells. This helps to reduce side-effects and damage. Yet, many people do experience some side-effects. See more general information about Capecitabine on Drugs.com.

Triple negative breast cancer has relatively high relapse rates despite anthracycline and taxane therapy. In the CREATE-X trial, Xeloda was found to significantly reduce relapse rates in patients who had residual disease after neo-adjuvant chemotherapy. Another trial that was started about 14 years ago when adjuvant therapy was the standard of care (CIBOMA/GEICAM) failed to show improved survival in patients receiving adjuvant therapy. This was somewhat of a surprise. However, survival improved in a prespecified subgroup of patients with non-basal-like TNBC. The 5 year disease-free survival rate of this subgroup (a mix of early stage TNBC) was 82.6% versus 72.9% without Xeloda. Overall survival (disease and disease-free) at 5 years was also substantially better (89.5% were alive versus 79.6% without).

As we learn more about TNBC, it is clear that it is a mixed disease. Xeloda use is currently very commonly used in patients with residual disease following neo-adjuvant therapy. However, it is not often used in the setting of surgery followed by adjuvant therapy. Given the results of CREATE-X and CIBOMA/GEICAM trials, Miguel Martin, MD, PhD, in his presentation at the 2018 San Antonio Breast Cancer Symposium, said "...We strongly recommend that patients with triple-negative breast cancer discuss adjuvant capecitabine with their oncologists. I couldn't agree more.

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