Dr. Barr on Temozolomide and Capecitabine in Neuroendocrine Tumors

Jodie Barr, DO, hematologist/oncologist, Lawrence Memorial Hospital, discusses the combination of temozolomide and capecitabine in neuroendocrine tumors (NETs).

Findings of small studies have confirmed the efficacy of combination therapy with capecitabine and temozolomide. Data from NYU Langone Health has suggested that the combination has an important cell-directed cycle effect on tumor cells.

In a study that examined the combination, patients were randomized to either temozolomide and capecitabine or temozolomide. The rationale stemmed from capecitabine’s potential synergistic effect with temozolomide in depleting O⁶-Methylguanine-DNA methyltransferase, says Barr.

The trial enrolled patients with grade 1/2 disease. The study was not blinded, which served as a bias of the study. Investigators examined progression-free survival (PFS) as the primary endpoint and found a significant benefit in PFS with capecitabine and temozolomide. The interim analysis showed hints of benefit in overall survival as well, says Barr.

Although its efficacy has been proven in a number of small studies, the combination regimen is more complex. Patients must take 1 of the drugs 2 out of the 4 weeks and the other drug every 10 to 14 days.