Comparison of the efficacy and safety of docetaxel plus capecitabine versus docetaxel plus epirubicin for human epidermal growth factor 2 -negative breast cancer: a meta-analysis.

Background: This study aimed to evaluate the efficacy and safety of docetaxel plus capecitabine (TX) and docetaxel plus epirubicin (TE) in the treatment of human epidermal growth factor 2 (HER2)-negative breast cancer.

Methods: Relevant studies assessing the efficacy and safety of TX versus TE were systematically searched from PubMed, Cochrane Library, Embase, and Web of Science databases until February 6, 2025. Progression-free survival (PFS), and clinical response, including the overall response rate (ORR), disease control rate (DCR), and grade 3/4 adverse events were compared.

Results: Four articles with moderate methodological quality were included. The pooled results revealed no significant differences in PFS (hazard ratio [HR] (95% confidence interval CI) = 0.86 (0.70, 1.05), P = 0.14), ORR (risk ratio [RR] (95%CI) = 1.02 (0.92, 1.14), P = 0.71), or DCR (RR (95%CI) = 1.02 (0.92, 1.14), P = 0.71) between the TX and TE groups. For grade 3/4 adverse events, only the combined results for neutropenia (RR (95%CI), 0.71 (0.52, 0.95); P = 0.02) and hand-foot syndrome (RR (95%CI) = 14.36 (3.45, 59.84); P = 0.0003) demonstrated significant differences between the two groups. No significant differences were observed in other adverse events, including febrile neutropenia, anemia, thrombocytopenia, nail/hair toxicity, hepatic toxicity, diarrhea, nausea, vomiting, infection, asthenia, and neuropathy.

Conclusion: In patients with HER2-negative breast cancer, TX and TE have comparable survival benefits and efficacy. However, TX exhibits a reduced incidence of neutropenia, but a higher likelihood of hand-foot syndrome than that observed in TE.