How do you sequence radiation and capecitabine in breast cancer patients receiving adjuvant capecitabine for residual disease after neoadjuvant chemotherapy?  

According to personal communication with Dr. Masakazu Toi (June 13, 2017), the corresponding author of the CREATE-X NEJM publication, radiotherapy was administered prior to capecitabine in the majority of cases on this study. It is worth noting that in CALGB 49907, a randomized trial comparing capec...

In the CREATE-X trial "postsurgical radiotherapy could be given before or after capecitabine" and therefore either of these sequences are consistent with the published result.Several retrospective studies showed that delaying regular adjuvant chemotherapy by 30-90 days does not have any detectable a...

It is worth noting that the capecitabine dose/schedule administered in CREATE-X (1250 mg/m2 bid on days 1 to 14 every 3 weeks for six or eight cycles) is challenging to administer. The study was conducted in Asia and it is possible that pharmacogenomic differences across specific populations impact ...

Our preference is to administer radiation first followed by adjuvant capecitabine, in accordance with the majority of patients treated in the CREATE-X trial.

An option I often employ is a 'sandwich' technique - to complete 4 cycles of capecitabine before radiation then resume capecitabine for the remaining 4 cycles after completing radiation. Giving radiation concurrent with full dose capecitabine can be associated with significant in-field toxicity. The...

Does anyone dose reduce xeloda (in certain high risk situations) and give with radiation for a couple of cycles and then escalate after completion of XRT?