Temozolomide-capecitabine (TemCap) chemotherapy for neuroendocrine neoplasms (NENs): Time to maximum response and optimal treatment duration

Lamarca, Ángela; Barriuso, Jorge; McCallum, Lynne; Papaxoinis, George; Nasralla, Magdy; Nuttall, Christina; Frizziero, Melissa; Kordatou, Zoe; McNamara, Mairéad G.; Mansoor, Was; Valle, Juan W.

doi:10.1093/annonc/mdx368.024

Cited by 4 publications

(3 citation statements)

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“…Although the optional treatment cycles and duration of chemotherapy are still unknown, a retrospective study of TEM plus capecitabine showed that maintenance therapy until progression is appropriate for patients who were progression free at 6 months and had good tolerance to treatment. [ 38 ] The early discontinuation of chemotherapy may be one of the reasons for the relatively short PFS in this study.…”

Section: Discussionmentioning

confidence: 96%

Effect of Endostar combined with chemotherapy in advanced well-differentiated pancreatic neuroendocrine tumors

et al. 2018

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The aim of the present study was to assess the effect of Endostar and temozolomide or dacarbazine plus 5-fluorouracil (5-FU) in patients with advanced pancreatic neuroendocrine tumors (pNETs).Phase II study of 14 patients with locally advanced or metastatic well-differentiated pNETs treated between April 2013 and September 2016. Patients received temozolomide or dacarbazine plus 5-FU, and Endostar. The primary outcome was the radiographic response rate.All 14 patients had nonfunctional pNETs. Six patients received temozolomide and 8 received dacarbazine + 5-FU, combined with Endostar. Thirteen patients were assessable for treatment response: 1(7%) with complete response, 5 (39%) with partial response, 5 (39%) with stable disease, and 2 (15%) with progression. The median progression-free survival was 12 months. The most common grade 1/2 toxicities were neutropenia (43%) and leucopenia (21%).Endostar combined with temozolomide or dacarbazine + 5-FU was effective in the treatment of advanced pNETs. The combinations were well tolerated.

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Section: Discussionmentioning

confidence: 96%

Effect of Endostar combined with chemotherapy in advanced well-differentiated pancreatic neuroendocrine tumors

et al. 2018

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“…Given the long-term risks of temozolomide, a fixed-dose approach has been suggested as an alternative strategy to minimize CAPTEM, they are unlikely to achieve it with further treatment. 34 Based on this data, they suggest a strategy in which patients who achieve a PR in the first 6 months adopt the "prolonged approach," while suggesting strong consideration be given for early cessation to those who do not achieve PR within 6 months. 15 At the same time, a more recent retrospective study 35 suggested higher PFS with prolonged (more than 12 cycles) treatments of capecitabine and temozolomide, with optional capecitabine maintenance and did not report on significant findings of myelodysplasia.…”

Section: Discussionmentioning

confidence: 99%

“…Given the long‐term risks of temozolomide, a fixed‐dose approach has been suggested as an alternative strategy to minimize unnecessary exposure to myelotoxicity and to preserve bone marrow reserve. Lamarca et al have determined that if patients did not achieve a partial response (PR) in the first 6 months of treatment with CAPTEM, they are unlikely to achieve it with further treatment 34 . Based on this data, they suggest a strategy in which patients who achieve a PR in the first 6 months adopt the “prolonged approach,” while suggesting strong consideration be given for early cessation to those who do not achieve PR within 6 months 15 .…”

Section: Discussionmentioning

confidence: 99%

Temozolomide duration and secondary hematological neoplasms: A literature review and implications for patients with neuroendocrine neoplasms

Park

Amin

Trikalinos

2022

J Neuroendocrinology

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Evidence-based recommendations for the optimal duration and sequencing of temozolomide-based treatments in advanced neuroendocrine neoplasms are lacking.Here, we conducted a systematic review of the literature for a descriptive analysis of temozolomide-associated myelodysplasias and leukemias to guide treatment planning. A database search of PubMed and Embase was conducted to identify case reports and/or case series reporting secondary myelodysplasias or leukemias in the setting of temozolomide therapy. Key data items extracted from the studies were the temozolomide dose and duration, latency to hematological disorder, type of secondary malignancy and cytogenetics. Reported cases were summarized graphically. A total of 16 studies with 27 patient cases of therapy-related hematologic neoplasms were identified, all of which were case reports or case series. The median treatment duration and cumulative dose were 19 months and 18,000 mg/m 2 , respectively.Most patients (21/27) were diagnosed on, or after, 12 months, while only one patient was diagnosed before 6 months of treatment. Most of the patients were diagnosed, while still on treatment with temozolomide. Graphically, cases clustered around a cumulative dose of 10,000 to 30,000 mg/m 2 and a latency period of 10 to 40 months which translates to an approximate treatment duration of 12.5 to 37.5 months.Taken together, most reported treatment-related hematological neoplasms appear to develop on or beyond the 12-month mark, while patients are still on treatment with temozolomide. For patients with neuroendocrine neoplasms, where sequencing of multiple therapies is important, we suggest an approach to optimizing treatment duration by establishing disease response at 6 months before continuing further treatment and restricting treatment to or establishing closer vigilance beyond 12 months.

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Authors’ Response to the Letter by Lamarca et al. Entitled “Temozolomide-Capecitabine Chemotherapy for Neuroendocrine Neoplasms: The Dilemma of Treatment Duration” Regarding “Activity and Safety of Standard and Prolonged Capecitabine/Temozolomide Administration in Patients with Advanced Neuroendocrine Neoplasms”

et al. 2019

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Temozolomide-capecitabine (TemCap) chemotherapy for neuroendocrine neoplasms (NENs): Time to maximum response and optimal treatment duration

Cited by 4 publications

References 0 publications

Effect of Endostar combined with chemotherapy in advanced well-differentiated pancreatic neuroendocrine tumors

Effect of Endostar combined with chemotherapy in advanced well-differentiated pancreatic neuroendocrine tumors

Temozolomide duration and secondary hematological neoplasms: A literature review and implications for patients with neuroendocrine neoplasms

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