Abstract
Background. Numerous chemotherapeutic agents have antitumor activity in recurrent/metastatic (R/M) nasopharyngeal cancer (NPC). Evidence of capecitabine's effectiveness as monotherapy is limited. Capecitabine tolerability in solid malignancies has ethnic and geographical variability. We investigated capecitabine's tolerability and identified potential prognostic factors for clinical outcomes in R/M NPC. Methods. A consecutive retrospective cohort of patients who received capecitabine as the first recurrence, second- or third-line monotherapy for metastatic NPC (2011-2019) was reviewed concerning patient characteristics, pathological features, treatment outcomes, and toxicity. Results. Fifty-one patients were eligible (median age at diagnosis: 42 [35.5-52.5] years). Most patients (78.4%) tolerated a standard oral dose of 1,250 mg/m(2) capecitabine (2 weeks on/1 week off) in a 3-week cycle. The objective response rate was 49%, and the disease control rate was 66.7%, with a median response duration of 6.2 months. Hand-foot syndrome (HFS) was associated with a higher objective response rate (odds ratio, 5.1 [95% confidence interval: 1.18-21.98]; P=0.02). The median follow-up duration was 17.8 (interquartile range: 7.8-30.4) months. The median (95% confidence interval) progression-free survival and overall survival were 6.6 (4.3-8.8) and 32.7 (25.9-39.5) months, respectively. HFS (P=0.02), better performance status (P=0.02), and absence of brain metastasis (P=0.04) were associated with prolonged progression-free survival. Conclusion. Capecitabine monotherapy is effective and well-tolerated as a palliative treatment for R/M NPC. Despite the lower incidence of HFS in our patients, it remained a favorable prognostic factor for objective response and progression-free survival.