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Capecitabine Plus Temozolomide for Advanced Pancreatic Neuroendocrine Tumors


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Very few treatment options are available to patients with advanced pancreatic neuroendocrine tumors, but researchers found that patients treated with a combination of capecitabine and temozolomide had longer progression-free survival rates than those treated with temozolomide alone. The findings were presented by Pamela L. Kunz, MD, and colleagues at the 2022 ASCO Annual Meeting (Abstract 4004).

Pamela L. Kunz, MD

Pamela L. Kunz, MD

“This combination of drugs yielded the longest progression-free survival rates and highest response rates that have been seen in any study of this type for patients with pancreatic neuroendocrine tumors,” said Dr. Kunz, Associate Professor of Internal Medicine (medical oncology) at Yale School of Medicine, Director of the Center for Gastrointestinal Cancers at Smilow Cancer Hospital and Yale Cancer Center, and principal investigator of the clinical trial.

The randomized, phase II clinical trial compared the effects of temozolomide alone with those of temozolomide in combination with capecitabine. The trial, which included 144 patients, showed that the combination of capecitabine and temozolomide produced longer progression-free survival rates, higher response rates, and longer overall survival rates than temozolomide alone:

  • At the scheduled interim analysis, median progression-free survival was 14.4 months for temozolomide vs 22.7 months for capecitabine/temozolomide
  • In the final analysis, median overall survival was 53.8 months for temozolomide and 58.7 months for capecitabine/temozolomide
  • The response rate was 34% for temozolomide and 40% for capecitabine/temozolomide.

In addition, deficiency of the DNA repair enzyme methylguanine methyltransferase (MGMT) in the tumor tissue, was found to be associated with increased responses.

“This clinical trial is practice-changing, and the combination of capecitabine and temozolomide should be included as a standard treatment option for patients with advanced pancreatic neuroendocrine tumors,” said Dr. Kunz. “In addition, MGMT testing can be considered for select patients receiving temozolomide for whom response is a primary goal of treatment. However, testing is not recommended for routine use as confirmatory studies are needed.”

Disclosure: The findings are part of the ECOG-ACRIN E2211 trial, conducted through the National Cancer Institute and the National Clinical Trial Network. For full disclosures of the study authors, visit coi.asco.org.

 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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