Optimising the dose of capecitabine in metastatic breast cancer: confused, clarified or confirmed?

While ‘targeted’ drugs often take centre stage when considering developments in breast cancer, improved understanding, administration and use of chemotherapeutic agents also contribute to better outcomes for women with metastatic breast cancer. Moreover, these developments offer the potential for further improvements when chemotherapy and targeted agents are combined. In this article, we focus on capecitabine dosing in advanced breast cancer, review the available data and discuss the implications of this evidence on best treatment practice both for chemotherapy alone and for chemotherapy when combined with biological agents. It appears that a capecitabine starting dose of 1000 mg/m2 twice daily enables treatment to be administered for longer periods, providing continuous exposure to cytotoxic therapy and thus prolonging the duration of disease control. Although no randomised data are available comparing different doses of capecitabine, the cumulative evidence supports this approach.