More Comparison Studies: Capecitabine (Xeloda) vs Standard Chemotherapy

In an attempt to prevent recurrence of breast cancer, chemotherapy is given after surgery. This is known as adjuvant chemotherapy.

One of the standard adjuvant regimens is CMF (cyclophosphamide, methotrexate, and 5-FU). Compared to other adjuvant regimens the toxicity is moderate but all the drugs are given intravenously. About 15 years ago Roche developed capecitabine (Xeloda) an oral drug that is simply 5FU in oral form. The cost of this drug is several hundred times (yes you read that correctly) that of the intravenous drug but the thought apparently was that the drug would save visits to infusion centers, which are also expensive.

Now, as reported in NEJM there is evidence that the use of capecitabine is inferior to CMF as adjuvant treatment of breast cancer in women over age 65. Unfortunately it’s taken 15 years to find this out.

Medicynical note: This experience is yet another example of why we need to compare treatment regimens. It’s counter intuitive to argue against this notion unless you are a drug company. Or an insecure physician who’s ego can’t deal with another source of information, besides the bias offered by pharmaceutical companies.

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