xeloda

[Guest guest]

Dr Love: Here's another question that perhaps you can comment on Dr Sledge. "Could you please comment on the study that showed that Taxotere plus Xeloda conferred a survival benefit in women with metastatic breast cancer?" Dr Sledge: That was a very interesting trial. Xeloda is a relatively new oral chemotherapy agent that is related to an older agent, 5-Fluorouracil. One of the interesting things that happened about a decade ago, was that in the adjuvant setting we had routinely used Fluorouracil as part of our treatment therapy regimens, about a decade ago based on little or no scientific evidence, we dropped Fluorouracil from our adjuvant chemotherapy regimens on a regular basis, at least here in the U.S. It's pretty clear now that that may have been a mistake. I think the trial that was just mentioned is one piece of evidence for that. This trial took patients with metastatic breast cancer and gave half of the patients Taxotere, a very active chemotherapy agent, and half Taxotere plus Xeloda and there was a survival advantage, albeit a modest one of about two to three months, for those with the combination of Taxotere and Xeloda. Now, there's a number of comments that can be made about this. Now it shows pretty clearly that taking a Fluorouracil-like agent such as Xeloda can be important from a survival standpoint. The study doesn't tell us, however, whether or not we need to take it in combination with Taxotere or if you'd get an equally beneficial result like taking the Xeloda after, or even before, the Taxotere. I mention this because one of the major benefits of Xeloda is that it's an oral chemotherapy agent, so what would be nice for many patients would be avoiding going to the doctor's office for an infusion every few weeks. And Xeloda might still have that benefit without being combined to Taxotere. Probably the greater importance of this study in the long run, however, is that we might not just see a few months of managing survival in women with metastatic breast cancer, but might actually see improvement in the cure rate if you were to move a drug like Xeloda into the adjuvant setting. Dr Love: Are there studies being planned to do that? Dr Sledge: That's my understanding. Not in the United States, but in Europe. Braun: I have one comment. One of the things I heard in that presentation is that potentially there is a synergistic effect between the two agents, and there might be an enzyme or protein, I guess, in the taxane that helps the conversion of the Xeloda into the 5-FU at the tumor site, which makes me think we have to look more at the actual use of the two in combination together, whether it be in the metastatic setting where it was studied or, as Dr Sledge has suggested earlier, in the adjuvant setting. Dr Sledge: Yes, that's certainly a possibility. This study didn't directly address that. One of the interesting things about the study was that, like many large randomized trials these days, it was conducted on an international basis. A large number of the patients in this trial were in countries where you couldn't get Xeloda outside the trial. So in fact only about 15% of the patients who got Taxotere alone crossed over to Xeloda as a single agent. So we just don't know in any way shape or form whether or not we need to give Xeloda with Taxotere or whether you'd get an identical result giving it before or following Taxotere. Dr Love: It's a good example of the fact that we have all these chemotherapy drugs and we get in the habit of giving them in a certain combination, but we don't always explore variations on that theme. Now some of these studies, like with Xeloda, are going back to 5-FU and re-exploring them. Braun: And adding perhaps better ways to administer the drugs. I know from what Dr Sledge said earlier about going back to the anthracyclines, for example, and I know there are some studies going on of those in a liposomal form. I don't know if that improves the delivery of those drugs, makes it easier for the patients to take