Addition of Capecitabine to Adjuvant Chemotherapy May be the Most Effective Strategy for Patients With Early-Stage Triple-Negative Breast Cancer: A Network Meta-Analysis of 9 Randomized Controlled Trials

Abstract

Background and ObjectivePrevious studies determined the therapeutic effects of capecitabine-based chemotherapy regimens on early-stage triple-negative breast cancer (TNBC). However, the optimal strategy of capecitabine-based chemotherapy remains uncertain. We conducted this network meta-analysis to address this issue.MethodsWe systematically searched PubMed, Embase, and the Cochrane Registry of Controlled Trials (CENTRAL) to retrieve eligible studies published before September 2021. Two independent reviewers extracted information from eligible studies using a pre-designed data extraction sheet. The primary outcome included disease-free survival, and the second outcome showed overall survival and adverse events. Direct meta-analysis was performed using RevMan 5.4, and Bayesian network analysis was performed using R version 3.6.1 with the “gemtc” and “rjags” packages.ResultsNine studies involving 3661 TNBC patients met the selection criteria. The network meta-analysis suggested that the addition of capecitabine to adjuvant chemotherapy achieved a significantly longer disease-free (HR = 0.66, 95% CrI = 0.49 to 0.86) and overall survival time (HR = 0.60, 95% CrI = 0.43 to 0.83) than standard chemotherapy. All comparisons did not achieve statistical significance. The addition of capecitabine to adjuvant chemotherapy was the most effective treatment for improving disease-free (81.24%) and overall survival (78.46%) times, and the replacement of capecitabine to adjuvant chemotherapy was the safest regime.ConclusionsBased on available evidence, capecitabine-based chemotherapy benefits TNBC patients, and the addition of capecitabine with adjuvant chemotherapy was the most effective regime. In contrast, the replacement of capecitabine to adjuvant chemotherapy was the safest regime. More studies of high quality and large scale are needed to confirm our findings.

Decreased Lung Metastasis in Triple Negative Breast Cancer Following Locally Delivered Supratherapeutic Paclitaxel-Loaded Polyglycerol Carbonate Nanoparticle Therapy

“…30 Capecitabine, when added to adjuvant chemotherapy, prolongs disease-free and overall survival in triple negative breast cancer patients as compared to standard therapy. 31 There is also emerging evidence that the addition of immunotherapy, such as PD1/PD-L1 inhibitors, to the treatment regimen may benefit patients with early-stage or advanced triple negative breast cancer. 32 For example, the addition of pembrolizumab to other neoadjuvant chemotherapy in patients with stage II− III TNBC, as reported in the KEYNOTE-522 clinical trial, results in a higher pathologic complete response at the time of surgery and reduced disease progression and recurrence as compared to patients who do not receive pembrolizumab over a median follow up period of 15.5 months.…”

“…The absence of surface receptor expression has led to the search for new therapeutic options . Capecitabine, when added to adjuvant chemotherapy, prolongs disease-free and overall survival in triple negative breast cancer patients as compared to standard therapy . There is also emerging evidence that the addition of immunotherapy, such as PD1/PD-L1 inhibitors, to the treatment regimen may benefit patients with early-stage or advanced triple negative breast cancer .…”

Bibliometric analysis and visualization of endocrine therapy for breast cancer research in the last two decade

“…Combination therapy methods, integrating antineoplastic agents, are increasingly adopted to enhance treatment results ( 54 ). Antineoplastic combined chemotherapy protocols have proven to be particularly valuable in managing hormone receptor-positive breast cancers ( 55 ).…”

Recent Advances in Drug Discovery for Triple-Negative Breast Cancer Treatment

“…In earlystage TNBC patients, capecitabine in combination with standard adjuvant chemotherapy showed significant disease-free survival and overall better survival outcomes than standard chemotherapy with tolerable adverse events [24]. A study showed that the addition of capecitabine-based chemotherapy was the most effective regime [25].…”