Galvani Linda, Zappi Arianna, Pusceddu Sara, Gelsomino Fabio, La Salvia Anna, Oldani Simone, Panzuto Francesco, Andrini Elisa, Lamberti Giuseppe, Campana Davide
Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
Endocrine. 2025 May;88(2):660-667. doi: 10.1007/s12020-025-04171-5. Epub 2025 Jan 24.
Lung neuroendocrine neoplasms (NENs) represent about 20% of all lung cancers. Few therapeutic options are available for atypical carcinoids (ACs). Single-agent temozolomide (TEM) is active in lung NENs, but whether the addition of capecitabine (CAPTEM) is associated with improved outcomes, is unknown. We sought to investigate the TEM-based therapies (TEM or CAPTEM) in patients with advanced AC.
This was a retrospective analysis of prospectively collected data from patients with AC of the lung referred to our institution from January 2003 to January 2023 who have received chemotherapy with either TEM or CAPTEM as any line treatment. Primary endpoint was progression free survival (PFS), secondary endpoints included overall response rate (ORR) and overall survival (OS).
In this study we included 31 patients with advanced AC. Median Ki-67 was 14.4% (3-30). CAPTEM in 17 patients (54.8%), while TEM was administered in 14 patients (45.2%). Overall, ORR was 39% (N = 12/31, all partial responses), while median PFS and OS were 57.4 months (95%CI: 43.2-71.7) and 24.4 months (95% confidence interval [95%CI]: 14.7-34.1). Median PFS was 33.9 months (15.6-52.1) in the CAPTEM group, while it was 15.5 (7.3-23.8) in the TEM group (p = 0.047). When adjusting for potential confounding factors, treatment with TEM vs CAPTEM retained its independent association with an increased risk of progression (HR: 4.01 [95%CI: 1.18-13.68]; p = 0.027).
Treatment with CAPTEM is associated with longer PFS than TEM alone in patients with AC. Prospective studies with larger sample size are needed to validate this finding.
肺神经内分泌肿瘤（NENs）约占所有肺癌的20%。对于非典型类癌（ACs），可用的治疗选择很少。单药替莫唑胺（TEM）在肺NENs中具有活性，但添加卡培他滨（CAPTEM）是否能改善预后尚不清楚。我们试图研究晚期AC患者基于TEM的治疗方法（TEM或CAPTEM）。
这是一项对2003年1月至2023年1月转诊至我院的接受TEM或CAPTEM化疗作为任何一线治疗的肺AC患者前瞻性收集数据的回顾性分析。主要终点是无进展生存期（PFS），次要终点包括总缓解率（ORR）和总生存期（OS）。
本研究纳入了31例晚期AC患者。Ki-67中位数为14.4%（3%-30%）。17例患者（54.8%）接受CAPTEM治疗，14例患者（45.2%）接受TEM治疗。总体而言，ORR为39%（N = 12/31，均为部分缓解），而PFS和OS的中位数分别为57.4个月（95%CI：43.2 - 71.7）和24.4个月（95%置信区间[95%CI]：14.7 - 34.1）。CAPTEM组的PFS中位数为33.9个月（15.6 - 52.1），而TEM组为15.5个月（7.3 - 23.8）（p = 0.047）。在调整潜在混杂因素后，TEM与CAPTEM治疗与进展风险增加仍保持独立关联（HR：4.01 [95%CI：1.18 - 13.68]；p = 0.027）。
在AC患者中，CAPTEM治疗比单独使用TEM具有更长的PFS。需要更大样本量的前瞻性研究来验证这一发现。
