New Protocol: Metronomic Capecitabine with Aromatase Inhibitors in Metastatic Breast Cancer

Randomized, open-label, phase 3 trial (MECCA)

HR+/HER2- metastatic breast cancer, treatment-naive in metastatic setting

Metronomic capecitabine (500 mg TID continuously) + AI vs. AI alone

ORR: 37.3% vs. 25.0%

mPFS: 20.9 mos vs. 11.9 mos (HR: 0.58 [0.43–0.76])

mOS: NR vs. 45.1 mos (HR: 0.58 [0.37–0.93])

3-yr OS: 79% vs. 63%

5-yr OS: 52% vs. 28%

Grade ≥3 AEs: 15.1% in combination arm

Most common AEs: Palmar-plantar erythrodysesthesia, peripheral neuropathy

Discontinuation due to AEs: 16.7% vs. 5.5%

Hong RX,Xu F,Xia W Metronomic Capecitabine Plus Aromatase Inhibitor as Initial Therapy in Patients With Hormone Receptor Positive, Human Epidermal Growth Factor Receptor 2 Negative Metastatic Breast Cancer: The Phase III MECCA Trial

Reviewed by Ulas D. Bayraktar, MD on Apr 22, 2025