First-line chemotherapy with capecitabine and temozolomide in patients with metastatic pancreatic endocrine carcinomas

Abstract

Background: Temozolomide is an active agent in metastatic pancreatic endocrine carcinomas. In vitro data indicate that the combination of capecitabine and temozolomide is synergistic for induction of apoptosis in neuroendocrine tumor cell lines. The authors retrospectively evaluated the efficacy of capecitabine and temozolomide in 30 patients with metastatic pancreatic endocrine carcinomas to assess response rate, progression free survival (PFS), and overall survival (OS).

Methods: Patients with metastatic, well, or moderately differentiated pancreatic endocrine carcinomas who had not received prior systemic chemotherapy were treated with capecitabine (750 mg/m² twice daily, days 1-14) and temozolomide (200 mg/m² once daily, days 10-14) every 28 days.

Results: Among 30 patients treated, 21 (70%) patients achieved an objective radiographic response. Median progression-free survival was 18 months. The rate of survival at two years was 92%. Only 4 patients (12%) experienced grade 3 or 4 adverse events.

Conclusions: The combination of capecitabine and temozolomide is associated with an exceptionally high and durable response rate in metastatic endocrine carcinomas of the pancreas. Clinical endpoints, including response rate, survival, and toxicity, are superior to those observed with streptozocin-based regimens.

Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES

The authors made no disclosures.

Copyright © 2010 American Cancer Society.

Figures

Figure 1

Waterfall plot illustrating best radiographic response (percent change) in each patient.

Figure 2

CT scans of three patients who had an exceptionally favorable response to chemotherapy. Column A (baseline scan); Column B (maximal response).

Figure 3

Overall survival from onset of treatment.

Figure 4

Progression-free survival.