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. 2025 May;88(2):660-667.
doi: 10.1007/s12020-025-04171-5. Epub 2025 Jan 24.

Capecitabine and temozolomide or temozolomide alone in patients with atypical carcinoids

Linda Galvani  1 , Arianna Zappi  1 , Sara Pusceddu  2 , Fabio Gelsomino  3 , Anna La Salvia  4   5 , Simone Oldani  2 , Francesco Panzuto  6   7 , Elisa Andrini  1 , Giuseppe Lamberti  8 , Davide Campana  1   9
Affiliations

Capecitabine and temozolomide or temozolomide alone in patients with atypical carcinoids

Linda Galvani et al. Endocrine. 2025 May.

Abstract

Background: 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.

Material and methods: 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).

Results: 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).

Conclusions: 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.

Keywords: Atypical carcinoids; CAPTEM; Chemotherapy; Lung neuroendocrine neoplasms; TEM.

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Conflict of interest statement

Compliance with ethical standards. Conflict of interest: F.G. received honoraria for speaker/advisory roles from Servier, Eli Lilly, Iqvia, Merck Serono, Amgen, and Bristol-Myers Squibb outside the present work. D.C. received honoraria for speaker/advisory roles from Ipsen, Novartis and Esteve outside the present work. F.P., A.L.S., G.L., L.G., A.Z., S.P., and S.O.: no competing interests. Ethics approval: The study was approved by local IRB (Comitato Etico indipendente, IRCCS Policlinico Sant’Orsola-Malpighi of Bologna, protocol code: SOCRATE, 787/2019/Oss/AOUBo) and was conducted in accordance with the principles of the Declaration of Helsinki (revision of Edinburgh, 2000).

Figures

Fig. 1
Fig. 1
Kaplan–Meier estimates of progression-free survival in the overall population
Fig. 2
Fig. 2
Kaplan–Meier estimates of progression-free survival by treatment. CAPTEM Capecitabine and temozolomide, TEM temozolomide
Fig. 3
Fig. 3
Kaplan–Meier estimates of overall survival in the overall population
Fig. 4
Fig. 4
Kaplan–Meier estimates of overall survival by treatment. CAPTEM Capecitabine and temozolomide, TEM temozolomide
See this image and copyright information in PMC

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