Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India.
Radiation Medicine Centre, Babha Atomic Research Centre, Tata Memorial Hospital Annexe, Homi Bhabha National Institute (HBNI), Mumbai, India.
Neuroendocrinology. 2021;111(10):998-1004. doi: 10.1159/000511987. Epub 2020 Oct 5.
Capecitabine-temozolomide (CAPTEM) chemotherapy, alone or with concurrent peptide receptor radionuclide therapy (PRRT), has activity in advanced WHO grade 2 and grade 3 neuroendocrine neoplasms (NENs). The objective of this study was to evaluate the activity of the CAPTEM in patients with grade 2 and grade 3 NENs and identify prognostic factors.
A retrospective analysis of patients with metastatic grade 2 and grade 3 NENs, who were having baseline significant dual uptake on 68Ga-DOTATATE/18F-fluorodeoxyglucose (FDG)-PET-CT scan and treated with CAPTEM chemotherapy between January 2014 and December 2019 at Tata Memorial Hospital, was conducted. The clinical variables and survival data were collected. Progression-free survival (PFS) was estimated using the Kaplan-Meier method.
A total of 68 patients received the CAPTEM regimen, of whom 29 patients (43%) received CAPTEM alone and 39 patients (57%) received concurrent PRRT. The primary sites were pancreas in 32 (47%) and small intestine in 12 (18%) patients. Mean Ki-67 index was 12.6% (range: 3-50). Forty-five patients (65%) were treatment naïve. There were no significant differences in baseline clinical variables between patients treated with CAPTEM alone or with CAPTEM-PRRT. Both regimens were well tolerated. With a median follow-up of 22.1 months, the median PFS for the entire cohort was 27.5 months. There was no statistical difference in the median PFS between patients receiving CAPTEM alone or CAPTEM-PRRT (33.7 vs. 22 months; p = 0.199). A Ki-67 index of >5% predicted for inferior PFS on multivariate analysis (24 versus 73.8 months; p = 0.04; hazard ratio -3.77; 95% confidence interval: 1.07-13.26).
CAPTEM, alone or concurrent with PRRT, has a significant activity in grade 2 and grade 3 NENs with dual SSTR and 18FDG expression. A Ki-67 index >5% predicts strongly for inferior outcomes and should be further explored as a prognostic cutoff in grade 2 NENs. Early initiation of CAPTEM should be considered in this group of tumors with significant baseline 18FDG expression.
卡培他滨-替莫唑胺（CAPTEM）化疗单独使用或与肽受体放射性核素治疗（PRRT）联合使用，对晚期 WHO 2 级和 3 级神经内分泌肿瘤（NENs）具有活性。本研究的目的是评估 CAPETM 在 2 级和 3 级 NENs 患者中的疗效，并确定预后因素。
回顾性分析了 2014 年 1 月至 2019 年 12 月在塔塔纪念医院接受过转移性 2 级和 3 级 NENs 治疗且基线时 68Ga-DOTATATE/18F-氟脱氧葡萄糖（FDG）-PET-CT 扫描显示明显双重摄取的患者，采用 CAPETM 化疗。收集临床变量和生存数据。使用 Kaplan-Meier 方法估计无进展生存期（PFS）。
共 68 例患者接受了 CAPETM 方案治疗，其中 29 例（43%）单独接受 CAPETM 治疗，39 例（57%）同时接受 PRRT。原发部位为胰腺 32 例（47%），小肠 12 例（18%）。Ki-67 指数平均为 12.6%（范围：3-50）。45 例（65%）患者为初治。单独接受 CAPETM 治疗或 CAPETM-PRRT 治疗的患者之间，基线临床变量无显著差异。两种方案均耐受良好。中位随访 22.1 个月，全队列的中位 PFS 为 27.5 个月。单独接受 CAPETM 或 CAPETM-PRRT 治疗的患者中位 PFS 无统计学差异（33.7 与 22 个月；p = 0.199）。多变量分析显示，Ki-67 指数>5%预示 PFS 较差（24 与 73.8 个月；p = 0.04；风险比-3.77；95%置信区间：1.07-13.26）。
CAPETM 单独使用或与 PRRT 联合使用，对 SSTR 和 18FDG 双重表达的 2 级和 3 级 NENs 具有显著活性。Ki-67 指数>5%强烈预示着预后不良，应进一步作为 2 级 NENs 的预后截断值进行探讨。对于基线 18FDG 表达显著的这类肿瘤，应考虑早期使用 CAPETM。
