OBJECTIVE We conducted a systematic review to estimate efficacy and safety of ixabepilone plus capecitabine compared with capecitabine alone for patients of anthracycline- and/or taxane-resistant metastatic breast cancer. METHODS PubMed, Cochrane Library, EMBASE, ClinicalTrials.gov and other databases were searched. Randomized controlled trials containing ixabepilone plus capecitabine for anthracycline- and/or taxane-resistant metastatic breast cancer were eligible. Studies were assessed for eligibility and quality, and data were extracted by two independent reviewers. Overall response rates and toxicity were analyzed as dichotomous variables. Overall survival and time to progression data were analyzed as inverse variables. Meta-analyses were carried out by Review Manager 5.0 Software. RESULTS This report included two large clinical trials (1973 patients) for patients with metastatic breast cancer resistant to taxanes and resistant to or pretreated with anthracyclines. Ixabepilone plus capecitabine has prolonged the median time to progression, increased overall survival and significantly increased response rates compared with capecitabine alone. Adverse events observed with the combination arm were generally manageable and well tolerated with neutropenia and febrile neutropenia, and peripheral neuropathy, myalgia, diarrhea, stomatitis and hand-foot syndrome were easily controlled. CONCLUSIONS Ixabepilone plus capecitabine demonstrated clinical activity with an acceptable safety profile, which seems to be a valid option for patients with anthracycline-pretreated/resistant and taxane-resistant metastatic breast cancer.