Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Pancreatic Cancer Institute, Shanghai, China; Pancreatic Cancer Institute, Fudan University, Shanghai, China.
Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Pancreatic Cancer Institute, Shanghai, China; Pancreatic Cancer Institute, Fudan University, Shanghai, China.
Endocr Pract. 2022 Mar;28(3):292-297. doi: 10.1016/j.eprac.2021.08.008. Epub 2021 Aug 25.
The role of alternate sequential administration of sunitinib and capecitabine/temozolomide (CAPTEM) in metastatic pancreatic neuroendocrine tumors (PanNETs) remains unexplored. We thus aimed to analyze the efficacy and tolerability of this strategy in advanced grade 1/grade 2 PanNETs.
In total, data of 43 patients with metastatic PanNET were collected from a real-world database of a cancer center. Twenty-four patients were treated with sunitinib followed by CAPTEM (group 1), and 19 patients were treated with CAPTEM followed by sunitinib (group 2).
Twenty-three patients were treated with first-line sunitinib or CAPTEM, and 20 patients were pretreated with somatostatin analog (SSA) or SSA in combination with transcatheter arterial chemoembolization. The objective response rate with first-line treatment was similar in both groups, whereas that with second-line treatment was higher in group 1 than in group 2, albeit with no significant differences (21.1% vs 5.3%, respectively; P = .205). Median progression-free survival (mPFS) for first-line and second-line treatments did not differ between the 2 groups (11 and 12 months vs 12 and 8 months, respectively). Following subgroup analyses, treatment with first-line sunitinib and sunitinib after pretreated SSA had a longer mPFS than that with second-line sunitinib after CAPTEM (11 months vs 8 months, respectively; P = .046), whereas treatment with first-line CAPTEM and CAPTEM after pretreated SSA had an mPFS similar to that of second-line CAPTEM after sunitinib treatment. CAPTEM and sunitinib had similar tolerability.
Alternating sunitinib and CAPTEM were well tolerated and associated with similar mPFS in grade 1/grade 2 PanNETs. However, larger prospective studies are required to investigate the efficacy of alternate sequential therapies for metastatic PanNET.
替西罗莫司和卡培他滨/替莫唑胺（CAPTEM）交替序贯给药在转移性胰腺神经内分泌肿瘤（PanNETs）中的作用仍未得到探索。因此，我们旨在分析该策略在高级别 1/2 级 PanNETs 中的疗效和耐受性。
我们从一家癌症中心的真实世界数据库中收集了 43 例转移性 PanNET 患者的数据。24 例患者接受舒尼替尼治疗后接受 CAPTEM 治疗（组 1），19 例患者接受 CAPTEM 治疗后接受舒尼替尼治疗（组 2）。
23 例患者接受一线舒尼替尼或 CAPTEM 治疗，20 例患者接受生长抑素类似物（SSA）或 SSA 联合经导管动脉化疗栓塞预处理。两组一线治疗的客观缓解率相似，而二线治疗的缓解率在组 1 中高于组 2，但差异无统计学意义（分别为 21.1%和 5.3%；P=0.205）。两组一线和二线治疗的中位无进展生存期（mPFS）无差异（分别为 11 个月和 12 个月，12 个月和 8 个月）。在亚组分析中，一线治疗使用舒尼替尼和 SSA 预处理后使用舒尼替尼的 mPFS 长于二线治疗使用 CAPTEM 后使用舒尼替尼（11 个月比 8 个月；P=0.046），而一线治疗使用 CAPTEM 和 SSA 预处理后使用 CAPTEM 的 mPFS 与二线治疗使用舒尼替尼后使用 CAPTEM 的 mPFS 相似。CAPTEM 和舒尼替尼具有相似的耐受性。
替西罗莫司和卡培他滨/替莫唑胺交替序贯给药在 1/2 级 PanNETs 中耐受良好，与相似的 mPFS 相关。然而，需要更大规模的前瞻性研究来探讨转移性 PanNET 交替序贯治疗的疗效。
Zotero 插件