Capecitabine and temozolomide in patients with advanced pulmonary carcinoid tumours

: Background Temozolomide and capecitabine (CAPTEM) chemotherapy is known to be active in patients with pancreatic neuroendocrine tumours (NET). Objective This retrospective analysis set out to describe the efficacy and toxicity of CAPTEM in patients with advanced pulmonary carcinoids (PC). Methods Patients were included with advanced PC who had been treated with a maximum of 6 cycles of oral temozolomide 200 mg/m2 day 10-14 and capecitabine 750 mg/m2 BID day 1-14, repeated every 28 days, followed by monthly intramuscular injection of octreotide 30mg long acting release (LAR) as maintenance treatment. Results Of the 33 patients, all with well differentiated PC; 61% had atypical carcinoid, 36% had Ki-67 index >10% and 42% had ≥3 organs involved by metastasis. CAPTEM was administered as first line treatment in 42% of patients and 17% had received prior somatostatin analogue treatment. Six patients (18%) achieved a partial response, 19 (58%) had stable disease and 8 (24%) developed progressive disease. After a median time of follow-up of 34.8 months, median progression-free survival (PFS) was 9.0 months and median overall survival (OS) 30.4 months. Median duration of disease response was 21.7 months and median duration of disease control was 9.7 months. Patients with multi-organ metastasis had shorter PFS, but only when treated as second or third line with CAPTEM (p=0.023). Conclusions CAPTEM induced a modest response and PFS rate, comparable to other studies with temozolomide in patients with advanced PC. The efficacy of CAPTEM should be compared to that of monotherapy with temozolomide in a prospective clinical trial.