title: A prospective, phase 1/2 study of everolimus and temozolomide in patients with advanced pancreatic neuroendocrine tumor.
abstract: BACKGROUND
  Both everolimus and temozolomide are associated with single-agent activity in patients with pancreatic neuroendocrine tumor (NET). A phase 1/2 study was performed to evaluate the safety and efficacy of temozolomide in combination with everolimus in patients who have advanced pancreatic NET.
  
  
  METHODS
  Patients were treated with temozolomide at a dose of 150 mg/m(2) per day on days 1 through 7 and days 15 through 21 in combination with everolimus daily in each 28-day cycle. In cohort 1, temozolomide was administered together with everolimus at 5 mg daily. Following demonstration of safety in this cohort, subsequent patients in cohort 2 were treated with temozolomide plus everolimus at 10 mg daily. The duration of temozolomide treatment was limited to 6 months. Patients were followed for toxicity, radiologic and biochemical response, and survival.
  
  
  RESULTS
  A total of 43 patients were enrolled, including 7 in cohort 1 and 36 in cohort 2. Treatment was associated with known toxicities of each drug; no synergistic toxicities were observed. Among 40 evaluable patients, 16 (40%) experienced a partial response. The median progression-free survival duration was 15.4 months. Median overall survival was not reached.
  
  
  CONCLUSIONS
  Temozolomide and everolimus can be safely administered together in patients with advanced pancreatic NET, and the combination is associated with encouraging antitumor activity. Future studies evaluating the efficacy of combination therapy compared to treatment with either agent alone are warranted.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Chan
authors.forename: Lawrence
authors.initials: L
authors.lastname: Blaszkowsky
authors.forename: Keith
authors.initials: K
authors.lastname: Stuart
authors.forename: Andrew X
authors.initials: AX
authors.lastname: Zhu
authors.forename: Jill
authors.initials: J
authors.lastname: Allen
authors.forename: Raymond
authors.initials: R
authors.lastname: Wadlow
authors.forename: David P
authors.initials: DP
authors.lastname: Ryan
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Meyerhardt
authors.forename: Marielle
authors.initials: M
authors.lastname: Gonzalez
authors.forename: Eileen
authors.initials: E
authors.lastname: Regan
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Kulke
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D000068338:Everolimus; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D011446:Prospective Studies; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077204:Temozolomide; D016896:Treatment Outcome
chemical_list: D003606:Dacarbazine; D000068338:Everolimus; D020123:Sirolimus; D000077204:Temozolomide
keywords: everolimus; oncology; pancreatic neuroendocrine tumor; phase 1/2 study; temozolomide