title: Outcomes of patients treated with capecitabine and temozolamide for advanced pancreatic neuroendocrine tumors (PNETs) and non-PNETs.
abstract: BACKGROUND
  Retrospective studies have demonstrated high response rates among patients with advanced pancreatic neuroendocrine tumors (PNETs) treated with capecitabine and temozolamide (CapTem), while responses are infrequently seen among non-PNETs. The objective of the study was to describe progression free survival (PFS) among neuroendocrine tumor (NET) patients treated with CapTem, and to identify factors associated with better activity.
  
  
  METHODS
  Patients who were referred to one of five provincial cancer treatment centers between 2009 and 2013 for advanced NETs and initiated CapTem were included. Patients received Cap 1,500 mg/m(2) on days 1-14 and TMZ 200 mg/m(2) on days 10-14 every 28 days. Their characteristics and outcomes were retrospectively analyzed.
  
  
  RESULTS
  In our cohort, 29 patients (16 males) with a median age of 59 (range 26-76) received palliative CapTem, 15 of them as first-line chemotherapy. Primary tumors included pancreas (48.3%), small bowel (20.7%), lung (10.3%), unknown (10.3%), rectum (6.9%) and appendix (3.4%). Median number of cycles was three. Fifteen patients (51.7%) received CapTem as first-line chemotherapy and 14 (48.3%) as subsequent lines. Median PFS for the entire cohort was 4.7 months. PNETs had a median PFS of 4.9 months compared to 2.8 months for non-PNETs (P=0.178). Patients with PNETs who received CapTem in the first-line setting had a median PFS of 15.9 months as compared to only 3.1 months for the remainder [P=0.047, hazard ratios (HR) 0.342]. Patients with Ki67 above 5% and ≤5% had median PFS of 4.0 and 4.7 months, respectively (P=0.260).
  
  
  CONCLUSIONS
  CapTem showed good activity among PNETs, but its broader role in the treatment of carcinoid tumors remains unclear.
authors.affiliation: Department of Medical Oncology, BC Cancer Agency, Vancouver, British Columbia, Canada.
authors.forename: Renata D'Alpino
authors.initials: RD
authors.lastname: Peixoto
authors.affiliation: Department of Medical Oncology, BC Cancer Agency, Vancouver, British Columbia, Canada.
authors.forename: Krista L
authors.initials: KL
authors.lastname: Noonan
authors.affiliation: Department of Medical Oncology, BC Cancer Agency, Vancouver, British Columbia, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Pavlovich
authors.affiliation: Department of Medical Oncology, BC Cancer Agency, Vancouver, British Columbia, Canada.
authors.forename: Hagen F
authors.initials: HF
authors.lastname: Kennecke
authors.affiliation: Department of Medical Oncology, BC Cancer Agency, Vancouver, British Columbia, Canada.
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Lim
keywords: Carcinoid tumors; carcinomas; chemotherapy; pancreatic endocrine tumors; pancreatic neuroendocrine tumors (PNETs)
references.citation: Cancer. 1991 Jul 15;68(2):227-32
references.pmid: 1712661
references.citation: J Clin Oncol. 2006 Jan 20;24(3):401-6
references.pmid: 16421420
references.citation: J Clin Oncol. 2004 Dec 1;22(23):4762-71
references.pmid: 15570077
references.citation: Br J Cancer. 2011 Mar 29;104(7):1067-70
references.pmid: 21386841
references.citation: Eur J Surg Oncol. 1995 Jun;21(3):297-300
references.pmid: 7781801
references.citation: Cancer Res. 1987 Nov 15;47(22):5846-52
references.pmid: 3664486
references.citation: J Clin Oncol. 2012 Aug 20;30(24):2963-8
references.pmid: 22778320
references.citation: Oncol Rep. 2007 Jun;17(6):1461-7
references.pmid: 17487405
references.citation: N Engl J Med. 1992 Feb 20;326(8):519-23
references.pmid: 1310159
references.citation: N Engl J Med. 2011 Feb 10;364(6):501-13
references.pmid: 21306237
references.citation: Cancer. 2011 Jan 15;117(2):268-75
references.pmid: 20824724
references.citation: Clin Cancer Res. 2009 Jan 1;15(1):338-45
references.pmid: 19118063
references.citation: Semin Oncol. 1987 Sep;14(3):343-53
references.pmid: 2820064
references.citation: N Engl J Med. 1999 Mar 18;340(11):858-68
references.pmid: 10080850
references.citation: N Engl J Med. 2011 Feb 10;364(6):514-23
references.pmid: 21306238