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Integrated Capecitabine–Temozolomide with Radioembolization for Liver-Dominant G2 NETs: Long-Term Outcomes of a Single-Institution Retrospective Study

  • Clinical Investigation
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

Capecitabine–Temozolomide (CapTem) is an oral chemotherapy regimen for NETs. Both drugs are radiosensitizers. Integrating CapTem and Y90 transarterial radioembolization (TARE) in patients with grade 2 neuroendocrine tumor (NET) liver metastases achieved an encouraging objective response rate (ORR) and progression-free survival (PFS) in a feasibility study. This study expands that report to a larger cohort with longer follow-up.

Methods

Therapy consisted of monthly cycles of capecitabine 600 mg/m2 twice daily for 14 days and temozolomide 150–200 mg/m2 on day 10–14. Simulation angiography was performed during the initial cycle. The dominant lobe was treated with 90Y-resin microspheres using BSA dosimetry on day 7 of the second cycle of CapTem. Patients with bilobar disease had the other lobe treated on day 7 of the third or fourth cycle. CapTem was continued until progression or intolerance. Clinical and laboratory assessment was done monthly and imaging every 3 months.

Results

35/37 patients completed the prescribed regimen. Primary sites of disease were pancreas (16), lung (10), gut (7) and unknown (4). Mean duration of CapTem was 12 months (range, 4–32 months). ORR in the liver was 72% with a disease control rate of 100%. Median PFS was 36 months (95% CI, 25–45 months). Median overall survival was 41 months (95% CI, 24–87 months) from initiation of CapTemY90 therapy and 130 months (95% CI, 56–172 months) from initial diagnosis.

Conclusion

Chemoradiation with CapTem and TARE provided durable control of G2 NET liver metastases for substantially longer than expectations for embolotherapy or chemotherapy alone.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Neuroendocrine Tumor Program, Division of Interventional Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA

    Michael C. Soulen, Jeffrey I. Mondschein, Mandeep Dagli & Diana van Houten

  2. Neuroendocrine Tumor Program, Division of Medical Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA

    Ursina R. Teitelbaum, Jennifer Eads, Nevena Damjanov & Charles Schneider

  3. Department of Biostatistics, Epidemiology and Informatics, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA

    Rosemarie Mick

  4. Neuroendocrine Tumor Program, Division of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA

    Keith Cengel

  5. Neuroendocrine Tumor Program, Division of Gastroenterology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA

    David C. Metz

  6. Neuroendocrine Tumor Program, Department of Radiology, Abramson Cancer Center, University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Michael C. Soulen

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  1. Michael C. Soulen
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Correspondence to Michael C. Soulen.

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Conflict of interest

Dr. Soulen reports grants and personal fees from Guerbet LLC, personal fees from Genetech, grants from Pfizer, grants from Sirtex, personal fees from AstraZeneca, personal fees from Varian, outside the submitted work. Dr. Eads reports grants from Oncolys, Genentech, Merck, Seagen, Medimmune, AstraZeneca, Arcus, Amgen, Gilead, and Hutchmed and personal fees from Advanced Accelerator Applications, outside the reported work. The remaining authors report no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study has obtained IRB approval from the University of Pennsylvania and the need for informed consent was waived. For this type of study, consent for publication is not required.

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Soulen, M.C., Teitelbaum, U.R., Mick, R. et al. Integrated Capecitabine–Temozolomide with Radioembolization for Liver-Dominant G2 NETs: Long-Term Outcomes of a Single-Institution Retrospective Study. Cardiovasc Intervent Radiol 47, 60–68 (2024). https://doi.org/10.1007/s00270-023-03614-8

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