The role of capecitabine-based neoadjuvant and adjuvant chemotherapy in early-stage triple-negative breast cancer: a systematic review and meta-analysis

BackgroundThe role of capecitabine in neoadjuvant and adjuvant chemotherapy for early-stage triple-negative breast cancer (TNBC) is highly controversial. Our meta-analysis was designed to further elucidate the effects of capecitabine on survival in early-stage TNBC patients and its safety.MethodsPubMed, Embase, and papers presented at several main conferences were searched up to December 19, 2019, to investigate capecitabine-based versus capecitabine-free neoadjuvant and adjuvant chemotherapy in TNBC patients. Heterogeneity was assessed using I-2 test, combined with hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CI) computed for disease-free survival (DFS), overall survival (OS), and over grade 3 adverse events (AEs).ResultsA total of 9 randomized clinical trials and 3842 TNBC patients were included. Overall, the combined capecitabine regimens in neoadjuvant and adjuvant chemotherapy showed significantly improved DFS (HR=0.75; 95% CI, 0.65-0.86; P<0.001) and OS (HR=0.63; 95% CI, 0.53-0.77; P<0.001). In subgroup analysis, there were improvements in DFS in the groups with addition of capecitabine (HR=0.64; 95% CI, 0.53-0.78; P<0.001), adjuvant chemotherapy (HR=0.73; 95% CI, 0.63-0.85; P<0.001), and lymph node positivity (HR=0.62; 95% CI, 0.44-0.86; P=0.005). Capecitabine regimens were related to higher risks of diarrhea (OR=2.88, 95% CI 2.23-3.74, P<0.001), stomatitis (OR=2.01, 95% CI 1.53-2.64, P<0.001) and hand-foot syndrome (OR=8.67, 95% CI 6.70-11.22, P<0.001).ConclusionThis meta-analysis showed that neoadjuvant and adjuvant chemotherapy combined with capecitabine significantly improved both DFS and OS in early-stage TNBC patients with tolerable AEs. There were benefits to DFS in the groups with the addition of capecitabine, adjuvant chemotherapy, and lymph node positivity.

Automated summary

The meta-analysis demonstrated that combined neoadjuvant and adjuvant chemotherapy with capecitabine significantly improved DFS and OS in early-stage TNBC patients, with tolerable adverse events. There were benefits in DFS for patients with the addition of capecitabine, adjuvant chemotherapy, and lymph node positivity.