NANETS2022 15th Annual Multidisciplinary NET Medical Symposium NANETS 2022 Clinical – Nuclear Medicine/Interventional Radiology/Imaging (16 abstracts)
Radiosensitization for TARE: Does Duration of Chemotherapy Affect PFS?List of participants and their roles in the submission
Michael C. Soulen 1 , Ursina R. Teitelbaum 2 , Rosemarie Mick 3 , Jennifer Eads 2 , Jeffrey I. Mondschein 1 , Mandeep Dagli 1 , Diana van Houten 1 , Nevena Damjanov 2 , Charles Schneider 2 , Keith Cengel 4 & David C. Metz 5
1Division of Interventional Oncology, 2Division of Medical Oncology, 3Department of Biostatisitics, Epidemiology and Informatics, 4Department of Radiation Oncology, and 5Department of Gastroenterology; Neuroendocrine Tumor Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
Background: Capecitabine and temozolomide (CapTem) are classic radiosensitizers used in combination with radiation therapy for many cancers. A feasibility study of integrated CapTem and Y90 transarterial radioembolization (TARE) for neuroendocrine tumors (NETs) suggests synergy with PFS of 31 months exceeding historical controls. The impact of duration of chemotherapy after TARE on PFS is not known.
Methods: 36 subjects with liver-domianant grade 2 metastatic NETwere treated with capecitabine 600 mg/m2 twice daily for 14 days and temozolomide 150-200 mg/m2 in two divided doses on day 10-14, with 14 days between cycles. During the initial cycle of chemotherapy, the patient underwent simulation angiography with Tc99m-MAA SPECT. The dominant lobe was treated on day 7 of the second cycle of CapTem. Resin Y90 microspheres (SIR-Spheres; Sirtex Medical) were administered according to the body surface area method. Patients with bilobar disease had the other lobe was treated on day 7 of the third or fourth cycle. Clinical and laboratory assessment was done monthly and imaging performed every 3 months. CapTem was continued until progression or intolerance. Subjects were categorized by duration of CapTem into 3-6 mo, 7-12 mo, and >12 mo. PFS was estimated by Kaplan-Meier method and the groups compared by log rank test.
Results: Mean duration of CapTem was 12 months. 10 subjects were on CapTem for 3-6 months, 15 for 7-12 months, and 11 for 13-32 months. 14/36 (39%) stopped CapTem due to toxicities prior to disease progression. Median PFS was > 36 months in the 3-6 month chemo group; 23 months for the 7-12 month chemo group, and 30 months for those on chemo > 12 months (P=NS).
Conclusions: This limited subset analysis suggests the following hypotheses:
1. Prolonged administration of radiosensitizing chemotherapy does not increase PFS. A limited course of chemotherapy at the time of TARE maybe sufficient to achieve synergy. This could be tested in a prospective trial.
2. Chemotherapy-related toxicities leading to intolerance occur in a substantial proportion of patients, offering an opportunity to investigate de-escaltion of chemotherapy to improve quality of life without sacrificing disease control.
Abstract ID 21372
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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