Capecitabine and streptozocin ± cisplatin in advanced gastroenteropancreatic neuroendocrine tumours
Meyer T., Caplin ME., Navalkissoor S., Luong T-V., Qian W., Armstrong G., Lao-Sirieix S-H., Hardy R., Corrie PG., Valle JW., Talbot DC., Cunningham D., Reed N., Shaw A.
Background Cytotoxic chemotherapy is widely used for advanced, unresectable pancreatic and other gastrointestinal foregut neuroendocrine tumours (NETs) and the most commonly used regimen combines 5-fluorouracil with streptozocin. The NET01 trial was designed to investigate whether capecitabine combined with streptozocin was an acceptable regimen with or without adding cisplatin. Methods Patients with advanced, unresectable NETs of pancreatic, gastrointestinal foregut or unknown primary site were randomised to receive three-weekly capecitabine (Cap) 625 mg/m twice daily orally, streptozocin (Strep) 1.0 g/m intravenously on day 1, with or without cisplatin (Cis) 70 mg/m intravenously on day 1. The primary outcome measure was objective response. Secondary outcome measures included progression-free and overall survival, quality of life, toxicity and biochemical response. Results 86 (44 CapStrep, 42 CapStrepCis) patients were randomised. Best objective response rate was 12% (95% confidence interval (CI) = 2-22%) with CapStrep and 16% (95% CI = 4-27.4%) with CapStrepCis. Disease-control rate was 80% with CapStrep and 74% with CapStrepCis. The estimated median progression-free and overall survival were 10.2 and 26.7 months for CapStrep and 9.7 and 27.5 months for CapStrepCis. 44% of CapStrep and 68% of CapStrepCis patients experienced grade ≥3 adverse events. Interpretation The efficacies of the novel CapStrep ± Cis regimens were very similar. CapStrep was better tolerated than CapStrepCis. The trial was registered as EudraCT: 2004-005202-71 and ISRCTN: 35124268. © 2014 Published by Elsevier Ltd.