Let me start with the presentation of Dr Minckwitz, he was looking at elderly patients with early breast cancer.
Correct.
And he looked at whether to add capecitabine. He had what’s called a backbone of ibandronate, what was this study all about? What were they trying to do?
The question he was asking, I believe, was whether adding capecitabine to ibandronate, which is a bisphosphonate, and hormonal therapy in the patients that were ER positive, whether the addition of that improved patient outcome. Basically the result was negative in the sense that there was no difference between the arms of capecitabine and ibandronate and the ibandronate alone.
Now there’s a lot of questions, these are fairly old women and they had been given this bisphosphonate, was there a bisphosphonate benefit, do you think, coming out of this?
You can’t rule it out. Bisphosphonates have been shown to be in the ACBHE, the Austrian adjuvant trials have shown that they are beneficial, they improved in early breast cancer. We know that there’s some anti-tumour effect again from this; I wouldn’t say it’s huge but there is an anti-tumour effect of bisphosphonates. So it’s hard to rule that out. Obviously the study was not designed to ask that question because there was not an ibandronate free arm.
Now these patients, many of them had high risk early breast cancer, they did not respond to capecitabine. Is there a possibility that really it’s good not to treat them at all?
You mean with chemotherapy?
With chemotherapy, yes.
Yes, of course. It’s also possible that other chemotherapies may be effective and that’s the point he made, that this makes a case against capecitabine but does not rule out that other chemotherapies may be effective in this setting. I don’t think we can think of chemotherapy as generic, OK? These are different drugs, different targets, in some cases we don’t know the molecular targets of chemotherapy but I’m sure they have some and they are different. So it could be that other chemotherapies still have an effect, Capecitabine doesn’t seem to be the one based on this data.
