Xeloda: Xtending into early breast cancer welcome

1
Xeloda X-tending into earlybreast cancer
welcome

• Martine Piccart
• Institut Jules BordetBrussels, Belgium

2
Adjuvant therapy for breast cancer (BC)
New diagnosis
Hormonetherapy
Chemotherapy
No chemo
Surgery/RTonly
15 85
Pre-operative Adjuvant
30 70
CMF
Anthracycline taxane
C cyclophosphamide M methotrexate F 5-FU
RT radiotherapy
3
Adjuvant chemotherapy associated with improved
outcomes

• Meta-analysis of chemotherapy versus no
  chemotherapy in early BC1
• 24 reduction in risk of recurrence (plt0.00001)
• 15 reduction in risk of death (plt0.00001)
• Long-term follow-up of 20 years, illustrated by
  CMF experience (versus no chemotherapy)2
• 35 reduction in risk of recurrence (plt0.001)
• 24 reduction in risk of death (p0.03)

1Early Breast Cancer Trialists Collaborative
Group. Lancet 199835293042 2Bonadonna G, et
al. N Engl J Med 19953329016
4
Medical therapy for early-stage BC
New diagnosis
Hormonetherapy
Chemotherapy
No chemo
Surgery/RTonly
15 85
Pre-operative Adjuvant
30 70
CMF Anthracycline taxane
5
Benefits of neoadjuvant chemotherapy

• Neoadjuvant chemotherapy allows
• pre-operative tumour downstaging
• greater opportunity for breast-conserving surgery
• in-vivo chemosensitivity testing study of cancer
  biology
• early initiation of systemic therapy in a disease
  with a high distant-failure rate
• Neoadjuvant chemotherapy offers similar
  disease-free and overall survival benefits as
  adjuvant chemotherapy

6
Neoadjuvant chemotherapy results from clinical
trials
1Wolmark N, et al. J Natl Cancer Inst Monogr
20013096102 2Fisher ER, et al. Cancer
20029568195 3Van der Hage JA, et al. J Clin
Oncol 200119422437 4Hortobagyi GN, et al.
Cancer 198862250716 5Gianni L, et al. Proc Am
Soc Clin Oncol 20022134a (Abst 132) 6Bear HD,
et al. Breast Cancer Res Treat 200488(Suppl.
1)S16 (Abst 26)
Of involved axillary lymph nodes NR not
reported CRR clinical response rate pCR
pathological complete responsein tumour
7
Xeloda an attractive therapy for early-stage BC

• High single-agent efficacy in metastatic BC
• Several highly active combinations, with
• taxanes
• vinorelbine
• anthracyclines
• Favourable safety profile
• minimal myelosuppression, alopecia
• Undergoing further investigation in adjuvant and
  neoadjuvant settings

8
Addition of Xeloda to Taxotere extends survival
Estimatedprobability
ORR
TTP
1.0 0.8 0.6 0.4 0.2 0.0
XT (n255) 42 Taxotere (n256) 30
6.1 months 4.2 months
11.5
14.5
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28
Months
OShaughnessy J, et al. J Clin Oncol
200220281223
9
Xeloda X-tending into early breast cancer

• Redefining the management of early breast cancer
  with Xeloda Wolfgang Janni
• Integrating Xeloda into primary systemic therapy
  of breast cancer
• case study Marjorie Green
• surgeons perspective John Robertson
• nurses perspective Pauline McIlroy
• Closing remarks Martine Piccart