Latest Cancer TreatmentsDr. Mohammadreza Dabiri
Dr. Mohammadreza Dabiriفارسی
Treatment regimen

Adjuvant capecitabine after neoadjuvant treatment (CREATE-X)

HER2-negative breast cancer with residual disease, especially triple-negative

Updated: 28 October 20261 min read3 references

Summary for doctors

  • Residual disease after neoadjuvant chemotherapy in HER2-negative breast cancer [1].
  • Greatest benefit in triple-negative disease [1].

Dose and schedule

Capecitabine (CREATE-X)

HER2-negative breast cancer with residual disease after surgeryCycle length: Every 21 days

HER2-negative breast cancer with residual disease after surgery

DrugDoseRouteSchedule
Capecitabine1250 mg/m² twice a dayOral, after foodDays 1 to 14
Cycle length
Every 21 days
Duration
6 to 8 cycles

Dose as in CREATE-X [1].

Dose source: [3].

Evidence: CREATE-X (2017)

Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.

Premedication and supportive care

  • DPYD: before the first fluoropyrimidine dose, consider testing for DPD deficiency (DPYD genotype); in carriers of one reduced-function allele the starting dose is reduced by about 50%, and these drugs are contraindicated in complete deficiency [2].
  • Moisturising cream for the hands and feet from day 1.

Monitoring and dose adjustment

  • Grade 2 hand-foot syndrome or diarrhoea: hold until recovery; on recurrence: 75% of the dose.
  • Creatinine clearance 30 to 50: 75% of the dose; below 30: contraindicated.

Main evidence

Show detailsHide

CREATE-X: in triple-negative disease, 5-year disease-free survival rose from 56.1% to 69.8% and overall survival from 70.3% to 78.8% [1].

Related cancer types

Breast cancer

Treatment regimens (physicians)

AC followed by paclitaxel (dose-dense and weekly)TC regimen (docetaxel and cyclophosphamide): dose and scheduleTCHP regimen: dose and schedule in HER2-positive breast cancerWeekly paclitaxel with trastuzumab (APT regimen)KEYNOTE-522 regimen: pembrolizumab and chemotherapy in triple-negative breast cancerTrastuzumab emtansine (T-DM1, Kadcyla): dose and scheduleTrastuzumab deruxtecan (T-DXd, Enhertu): dose and monitoringSacituzumab govitecan (Trodelvy)Pembrolizumab with chemotherapy in metastatic triple-negative breast cancer (KEYNOTE-355)

Physician tools and lessons

Cumulative Anthracycline Dose and Doxorubicin Equivalents10 cheap steps that save patients' livesBone-modifying agents in cancer: bone metastases, adjuvant use and osteonecrosis of the jawGermline genetic testing in cancer: who, and which genes?Management of brain metastasesFertility preservation before cancer treatmentMalignant pleural effusion: drainage, pleurodesis or an indwelling catheterCancer during pregnancy: chemotherapy and decisions

References

3 references
Show all references, 2 with a study cardClose the reference list

Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.

  1. 1
    Adjuvant Capecitabine for Breast Cancer after Preoperative ChemotherapyMasuda N, Lee SJ, Ohtani S, et al · N Engl J Med · 2017;376:2147-2159
    Study cardDOIPubMed Back to text: 1 2 3 4
  2. 2
    Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Dihydropyrimidine Dehydrogenase Genotype and Fluoropyrimidine Dosing: 2017 UpdateAmstutz U, Henricks LM, Offer SM, et al · Clin Pharmacol Ther · 2018;103:210-216
    Study cardDOIPubMed Back to text
  3. 3
    CAPECITABINE — Prescribing InformationAurobindo Pharma Limited · FDA label · 2026
    Source Back to text

This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.

Printed from the website; the full and up-to-date version: https://drdabiri.com/en/regimens/capecitabine-adjuvant-create-x/

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