-Original-

Capecitabine + Epirubicin + Cyclophosphamide Combination Therapy (CEX Therapy) as Neoadjuvant Chemotherapy for HER-2-Negative Breast Cancer: A Retrospective, Single-Center Study

Tadashi Yokoyama¹, Hiroshi Makino¹, Natsuki Seki¹, Junji Ueda¹, Masaru Hosone², Hironori Katayama², Hiroyuki Takei³ and Hiroshi Yoshida⁴

¹Department of Surgery, Nippon Medical School Tama Nagayama Hospital
²Department of Pathology, Nippon Medical School Tama Nagayama Hospital
³Department of Breast Surgical Oncology, Nippon Medical School
⁴Department of Gastroenterological Surgery, Nippon Medical School

Background: We modified and administered capecitabine + epirubicin + cyclophosphamide combination therapy (CEX) as neoadjuvant chemotherapy (NAC) for HER-2-negative breast cancer and retrospectively analyzed its effectiveness and tolerability at our center.
Methods: The inclusion criteria were presence of breast cancer negative for HER-2 and positive lymph node metastasis, or negative lymph node metastasis when tumor diameter was 20 mm or greater without distant metastasis. Additional inclusion criteria were a performance status of 0 or 1, an EF >60%, and an age of 75 years or less. Clinical outcomes were evaluated after 4 courses of epirubicin 80 mg/m2, cyclophosphamide 500 mg/m2 (administered every 3 weeks), and capecitabine 1,500 mg/m2 (administered for 2 weeks and withdrawn for 1 week).
Results: A clinical benefit was noted in all 18 patients who received CEX as neoadjuvant chemotherapy during the period from 2009 through 2013. The clinical response rate was 83.3% (15/18), and the clinical complete response rate was 50%. Aesthetic outcomes of breast-conserving surgery were positive in all patients. Among patients with satisfactory outcomes, 33.3% had a pathologic complete response (triple-negative: 6, luminal: 0) and 68.8% were n0 (triple-negative: 8, luminal: 3). All patients with a pathologic complete response are presently alive, free of recurrence, and currently undergoing follow-up. Adverse events were classified as grade 2 or lower in all patients.
Conclusions: CEX therapy administered as neoadjuvant chemotherapy could be useful for individualized treatment. In particular, this regimen was effective for triple-negative breast cancer.

J Nippon Med Sch 2020; 87: 73-79

Keywords
breast cancer, neoadjuvant chemotherapy, 'CEX', triple-negative, pathologic complete response

Correspondence to
Tadashi Yokoyama, MD, PhD, Department of Surgery, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama, Tokyo 206-8512, Japan
yokotada@nms.ac.jp

Received, March 31, 2019
Accepted, October 29, 2019