The Role of Capecitabine/Temozolomide in Metastatic Neuroendocrine Tumors

• Published in: The oncologist (Dayton, Ohio) Ohio), 2016-06, Vol.21 (6), p.671-675
• Main Authors: Ramirez, Robert A., Beyer, David T., Chauhan, Aman, Boudreaux, J. Philip, Wang, Yi‐Zarn, Woltering, Eugene A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Capecitabine; Capecitabine - administration & dosage; Capecitabine - adverse effects; Chemotherapy; Dacarbazine - administration & dosage; Dacarbazine - adverse effects; Dacarbazine - analogs & derivatives; Disease-Free Survival; Endocrinology; Female; Humans; Ki-67 Antigen - analysis; Male; Middle Aged; Neoplasm Metastasis; Neuroendocrine tumors; Neuroendocrine Tumors - drug therapy; Neuroendocrine Tumors - mortality; Neuroendocrine Tumors - pathology; Temozolomide
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2015-0470

Background. Neuroendocrine tumors (NETs) are commonly treated with multimodality therapy. The combination of capecitabine and temozolomide (CAPTEM) has been suggested as a treatment option for patients with metastatic NETs. We present our experience with CAPTEM. Methods. Data on NET patients who were placed on CAPTEM and received at least one cycle were obtained from a Velos eResearch database. Response rate was calculated by RECIST 1.1. Overall survival and progression‐free survival (PFS) were calculated by the Kaplan‐Meier survival method. Results. A total of 29 patients (17 male and 12 female) were included. Median age at CAPTEM initiation was 58 years (range: 26–77). Primary tumors included 9 small bowel (31%), 15 pancreas (52%), 3 lung (10%), and 2 rectum (7%). Median number of CAPTEM cycles was 8 (range: 1–55). Partial response occurred in 5 patients (5 of 29, 17%); 14 patients (14 of 29, 48%) had stable disease, and 10 patients (10 of 29, 34%) had progressive disease. A total of 3 (20%) and 5 (33%) pancreatic NETs experienced partial response and stable disease, respectively. A total of 2 (14%) and 9 (64%) nonpancreatic NETs experienced partial response and stable disease, respectively. Partial response was noted in 1 patient (13%) and stable disease in 5 patients (63%) with Ki‐67 values of less than 2%. In patients with Ki‐67 values of 2%–20%, partial response was noted in 3 (19%) and stable disease in 8 (50%). Partial response and stable disease were noted in 1 patient each (20%) with Ki‐67 values greater than 20%. Median PFS was 12 months. Adverse reactions caused dose reductions in 24% of patients. Conclusion. Although adverse reactions were experienced, most patients tolerated this regimen. CAPTEM should be considered as a reasonable treatment option for metastatic NET patients. Implications for Practice: The role of chemotherapy in neuroendocrine tumors has evolved in recent years. The results of this study suggest that the combination of capecitabine and temozolomide provides an adequate treatment option and may prolong survival in patients with a wide variety of metastatic neuroendocrine tumors. Although prospective data are needed, this research adds to the abundance of retrospective experience with this combination that appears to show that capecitabine and temozolomide could potentially be an option for patients with advanced neuroendocrine tumors who have progressed on standard treatment. Analysis of data from 29 neuroendocrine tumor pat