Temozolomide Alone or Combined with Capecitabine for the Treatment of Advanced Pancreatic Neuroendocrine Tumor.

Abstract

BACKGROUND:

The combination of capecitabine (CAP) with temozolomide (TEM) chemotherapy in advanced pancreatic neuroendocrine tumors (PanNET) relies on limited evidence. We compared TEM-CAP to TEM alone in patients with advanced PanNET.

METHODS:

Consecutive patients with advanced PanNET treated with TEM or TEM-CAP between 2004 and 2017 in three expert centers were included. Progression-free survival (PFS), tolerance, tumor response, and overall survival were compared between the two groups. Propensity-based analyses were performed to reduce confounding bias due to the nonrandomized setting.

RESULTS:

TEM and TEM-CAP were administered to 38 patients and 100 patients, respectively, with a median age of 58 years. The patients in the TEM group more often had hormonal syndromes (p = 0.03), a longer median delay to diagnosis (p = 0.001), and a higher number of pretreatment lines (p < 0.001). The performance status was 0 in 58% versus 65% of the patients, and tumor's median Ki-67 index was 8% versus 11%, respectively. Tolerance was similar, except that there were more cases of asthenia in the TEM group (p = 0.017) and more cases of hand-foot syndrome in the TEM-CAP group (p = 0.025). The objective response rate was 34% versus 51% (p = 0.088). The raw median PFS was similar with TEM and with TEM-CAP (21.4 vs. 19.8 months, p = 0.84). Although CAP tended to decrease the risk of progression in Cox multivariate analysis (HR 0.65, p = 0.12), it had no effect after adjustment for the propensity score (HR 1.06, p = 0.80).

CONCLUSIONS:

TEM-CAP might not prolong PFS but might achieve a higher response rate than TEM alone. Hence, TEM-CAP might be preferred when tumor shrinkage is the main therapeutic objective. Otherwise, TEM might be adequate for patients with an impaired performance status or in case of extrahepatic metastases.

• Authors: Louis de Mestier, Thomas Walter, Camille Evrard, Paul de Boissieu, Olivia Hentic, Jérôme Cros, David Tougeron, Catherine Lombard-Bohas, Vinciane Rebours, Pascal Hammel, Philippe Ruszniewski
• Journal: Neuroendocrinology (Neuroendocrinology) Vol. 110 Issue 1-2 Pg. 83-91 ( 2020) ISSN: 1423-0194 [Electronic] Switzerland
• PMID: 31071715 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2019 The Author(s) Published by S. Karger AG, Basel.

Chemical References

• Antineoplastic Agents
• Capecitabine
• Temozolomide

Topics

• Adult
• Aged
• Antineoplastic Agents (administration & dosage, adverse effects, pharmacology)
• Capecitabine (administration & dosage, adverse effects, pharmacology)
• Drug Therapy, Combination
• Female
• Humans
• Male
• Middle Aged
• Neuroendocrine Tumors (drug therapy)
• Pancreatic Neoplasms (drug therapy)
• Temozolomide (administration & dosage, adverse effects, pharmacology)