Background: Pulmonary carcinoids (PC) are rare neuroendocrine tumors (NETs). The course of PCs is considered to be indolent, but patients with advanced disease have low survival rates and their treatment options are limited. As PCs are under-represented in trials, therapeutic decisions are based on evidence extrapolated from other types of NETS. Capecitabine-Temozolamide (CAPTEM) has demonstrated significant efficacy in pancreatic NETs. However, its role in PCs is still unexplored. The aim of this retrospective study was to examine the efficacy of CAPTEM in patients with advanced PC.
Methods: Patients with advanced PCs, received treatment with Capecitabine 750 mg/m2 twice daily (day 114) and Temozolamide 200 mg/m2 once daily (day 1014), in a 4 week cycle, up to 6 cycles. Patients were treated at the Christie NHS Hospital from March 2014 to August 2016.
Results: Twenty four patients were included in the analysis; 12 males, 12 females. Eight (33%) had typical and 15 (62.5%) had atypical histology. Median age was 63.5 years (range, 4779). EGOC performance status ranged from 0 (10 patients, 47.5%), 1 (9 patients, 37.5%) to 2 (5 patients, 20.8%). Six patients (25%) had previous chemotherapy; 5 of them (20.8%) received CAPTEM as second line cytotoxic treatment and 1 (4.2%) as a third line. The rest 18 patients (75%) were chemo-naïve. Ten patients (41.7%) completed all 6 cycles. The median number of cycles was 4 (range, 16). From 23 assessable patients, disease control rate with CAPTEM was 73.9%. Four (17.4%) patients had partial response, 13 (56.5%) had stable disease and 6 (26.1%) progressed. No patient achieved complete response. After a median follow up of 11.1 months (range 2.721.2) 15 patients progressed (62.5%) and 8 patients deceased (33.3%). Median time to progression was 5.5 months (95% CI=4.46.7). Overall survival has not been reached yet.
Conclusions: CAPTEM is an active treatment for PCs. The responses obtained in this analysis are similar with those described in the literature for PCs and other non-pancreatic NETs. Prospective trials are needed to confirm this efficacy and provide more information about predictive factors and the correct line of administration to optimise outcomes.
05 Dec 2016
UK and Ireland Neuroendocrine Tumour Society