CREATE-X-ing better outcomes.

Residual breast cancer after neoadjuvant chemotherapy has worse prognosis, especially triple-negative breast cancer. In the CREATE-X trial published yesterday in NEJM, patients with HER2(-) tumors and residual disease at surgery were randomized +/- to 6-8 cycles of adjuvant capecitabine (aka Xeloda). Five year disease-free survival (DFS) improved from 68% to 74% and overall survival (OS) from 84% to 89% with the addition of Xeloda. These effects were particularly promising in the triple-negative subset (HR for DFS 0.58 and for OS 0.52). Radiation was allowed to go before or after capecitabine, which will be an important logistical point in clinical practice.