Is there a role for adjuvant capecitabine in sequence with abemaciclib for high risk HR+ breast cancer with residual disease?

In high-risk, node-positive HR+ Her-2 neg breast cancer patients who received neoadjuvant chemotherapy with residual disease, would you give capecitabine over adjuvant abemaciclib or sequence the two?

1 Answer

Mednet Member

Medical Oncology · University of Iowa Holden Comprehensive Cancer Center

Answered on · Updated on

Several randomized trials and meta-analyses have failed to show the benefit of adding capecitabine in Neo-adjuvant or adjuvant setting, except for selected TNBC patients. GEICAM/2003-10 and FinXX are few of those well-conducted studies that explored the addition of capecitabine in early stage breast cancer.

For patients with residual disease after pre-operative chemotherapy, CREATE-X trial (Masuda et al., PMID 28564564) showed only a marginal 3% DFS and OS benefit among patients with hormone-receptor–positive disease, DFS (76.4% Vs. 73.4%) and OS (93.4% versus 90.0%).

In comparison, updated results on monarchE by Harbeck et al., PMID 34656740, showed absolute improvements in 3-year IDFS of 5.4% with the addition of abemaciclib.

In absence of head-to-head comparison, I would rate the efficacy of abemaciclib greater than Capecitabine in this setting and toxicity profile superior to Capecitabine.