Dr Chris Twelves on Capecitabine and Docetaxel – the development of new anti-cancer drugs and new treatment options for breast cancer.

Dr Chris Twelves from the University of Glasgow is involved with the development of new anti-cancer drugs and the CRC Clinical Trials Committee.

What does Xeloda (Capecitabine) plus Taxotere (Docetaxel) mean for the patient, her doctors and nurses?

‘If anyone had Metastatic Breast Cancer, half would be here next Christmas treated with Docetaxel alone, verses two-thirds if treated with combination’, said Dr Twelves.

With metastatic breast cancer, generally speaking, poor quality of life is due to the disease rather than the treatment. Many patients fear that chemotherapy reduces their quality of life however it is actually the disease. He said that a trial of about 20yrs ago that compared hormonal therapy for Metastatic Breast Cancer v chemotherapy, QOL was better in the chemotherapy arm than hormonal, because the treatment was more effective.

Reviewing the phase III trial data under discussion, it was definite that the Capecitabine combination was no worse for QOL than single agent Docetaxel. The global health status improved with time verses single agent treatment.

The main impact on QOL in combination was hand foot syndrome. Some discussion was given to preventing this with pyridoxine (vitamin B6).

Recommended Capecitabine starting dose for combination is the following:

• if the patient is fit, it is recommended 1250mg/m2 with Docetaxel 75mg/m2, however
• if the patient is less fit 75% of the dose is recommended i.e. Capecitabine 950mg/m2 with Docetaxel 75mg/m2.

Dr Twelves stressed the importance of patient, nurse, pharmacist and doctor education and the benefits of an outpatient based chemotherapy. He also noted they are looking at new trials of pre-operative AC followed by Docetaxel or AC followed by Docetaxel and Capecitabine.

Capecitabine and Docetaxel is the first cytotoxic combination to improve survival over Docetaxel alone in metastatic breast cancer.

Coming tomorrow will be a discussion by Professor Debu Tripathy on the current and future status of Herceptin.
This presentation will be telecast live on Tuesday, 26th November 2002. For further information, contact your local Roche representative.