Phase I-II Study of Radiopeptide177Lu-Octreotate in Combination with Capecitabine and Temozolomide in Advanced Low-Grade Neuroendocrine Tumors
- 1 November 2012
- journal article
- research article
- Published by Mary Ann Liebert Inc in Cancer Biotherapy & Radiopharmaceuticals
- Vol. 27 (9), 561-569
- https://doi.org/10.1089/cbr.2012.1276
Abstract
We conducted a phase I-II clinical trial to assess the safety and efficacy of combining lutetium-177 (177Lu)-octreotate with capecitabine and temozolomide in treating advanced low-grade neuroendocrine tumors (NETs). All 35 patients received fixed activities of 7.8 GBq 177Lu-octreotate each 8 weeks, with 14 days of capecitabine 1500 mg/m2 for 4 cycles. In phase I, successive cohorts of patients received escalating doses of temozolomide in groupings of 100, 150, and 200 mg/m2 in the last 5 days of each capecitabine cycle. In phase II, patients were treated with 200 mg/m2 temozolomide. Treatment was well tolerated in all dosage groups. No dose-limiting grade 2, 3, or 4 toxicities were seen in cohorts 1 (100 mg/m2) or 2 (150 mg/m2). Twenty-eight patients completed treatment at the 200 mg/m2 temozolomide level. Adverse events were mild to moderate. The commonest toxicities were transient nausea grade 2 (18%), grade 3 (3%), thrombocytopenia grade 2 (24%), and neutropenia grade 3 (6%). There were no grade 4 events. Thirty-four patients were evaluable for tumor response. Overall, complete response (CR) was achieved in 15% (95% CI 3–27); partial response (PR), in 38% (95% CI 22–55); stable disease (SD), in 38% (95% CI 22–55); and 3 patients failed to respond to treatment. Median progression free survival (PFS) was 31 months (95% CI 21–33), and median overall survival (OS) has not been reached with 90% surviving at 24 months follow-up (range 21–30). Overall objective response rate (ORR) in patients with gastroenteropancreatic NETs showed CR 16% (95% CI 3–28), PR 41% (95% CI 24–58), SD 37% (95% CI 21–54), and PD 6% (95% CI 0–15). Response rates were higher in patients with gastropancreatic NETs than in those with bowel primaries (enteric-NETs); CR 18% versus 13%, PR 64% versus 13%, SD 12% versus 67%. 177Lu-octreotate, in combination with capecitabine and temozolomide, is well tolerated in patients with advanced low-grade NETs, and shows substantial tumor control rates.Keywords
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