Capecitabine and Temozolomide as a Promising Therapy for Advanced Thymic Atypical Carcinoid

Abstract

Background Thymic atypical carcinoid (TAC) is a rare thymic neuroendocrine tumor that originates in the neuroendocrine system and lacks a standardized treatment. The combination of capecitabine (CAP) and temozolomide (TEM) is associated with an extremely high and long‐lasting response rate in patients with metastatic pancreatic neuroendocrine tumors. However, there is little evidence showing that the CAPTEM regimen is effective for TAC. For patients with unresectable or metastatic atypical carcinoid of the thymus, few treatment options are available, and the treatment efficacy is not satisfactory. To explore the efficacy and safety of the CAPTEM regimen against TAC, we conducted a retrospective review. Patients and Methods A total of nine patients with advanced atypical carcinoid of the thymus in the China‐Japan Friendship Hospital 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 between 2014 and 2018. The disease control rate (DCR), progression‐free survival (PFS), and adverse effects after treatment were analyzed. The DCR was calculated by RECIST version 1.1. Progression‐free survival was calculated by the Kaplan‐Meier survival method. Results A total of nine patients (six male and three female) were included. The median age at CAPTEM initiation was 50 years (range, 26–58). The median number of CAPTEM cycles was 8 (range, 3–23). The DCR was 89% (8/9), with eight patients achieving stable disease. Only one patient (11%) showed progressive disease. The median PFS was 8 months. Because we applied vitamin B6 and ondansetron before administering the drugs, the side effects of this regimen were very small. Adverse reactions were all below grade 3 and included myelosuppression and digestive tract reaction. Conclusion Our results suggest that the CAPTEM regimen may be effective and well tolerated for the treatment of TAC. More evidence is needed to validate the effectiveness of this regimen. Implications for Practice Capecitabine and temozolomide regimen is effective and well tolerated in patients with advanced thymic atypical carcinoid.

Outcomes of Capecitabine and Temozolomide (CAPTEM) in Advanced Neuroendocrine Neoplasms (NENs)

“…In the past year, recent studies have reported on the use of CAPTEM in advanced NEN [29][30][31][32][33]. Chatzellis et al (2019) conducted a retrospective analysis of CAPTEM in 79 patients, of which 30 patients (38%) had pNEN and 15 patients had GI NEN primary disease.…”

“…Recently published manuscripts have investigated the use of CAPTEM in this population. However, the number of patients available for study remain low [29,32,33,36].…”

Capecitabine and Temozolomide (CAPTEM) in Advanced Neuroendocrine Neoplasms (NENs): A Systematic Review and Pooled Analysis

“…[72][73][74][75] Furthermore, the efficacy of CAPTEM was mostly investigated in GEP-NETs but some evidences suggested a role also in NETs of lung and thymic origin and unknown primary site, irrespective of the treatment line. 61,65,76 We performed a systematic review to assess the efficacy and safety of CAPTEM, including long-term outcomes in patients affected with NENs, with the aim to better clarify the role of this regimen in the therapeutic algorithm of NENs.…”

Carcinoide atípico de timo en varón de 39 años: Reporte de caso

“…Otros estudios como los realizados por Wang X, etal. [14] demuestran que la combinación de capecitabina (CAP) y temozolomida (TEM) llamada también como régimen CAPTEM puede ser efectivo y bien tolerado para el tratamiento de CA de timo, aunque sugieren mayor evidencia para validar su eficacia.…”