Temozolomide well tolerated, effective in poorly differentiated endocrine carcinoma

Welin S. Cancer. 2011;doi:10.1002/cncr.26124.

Issue: December 2011

Temozolomide may be a viable option for second-line treatment in patients with poorly differentiated endocrine carcinoma, according to data published in Cancer. Researchers reported that patients who received temozolomide alone or combined with capecitabine and bevacizumab had a 71% objective response rate or stabilization.

From 2004 to 2009, 25 patients with poorly differentiated endocrine carcinoma, mostly gastrointestinal, who progressed on first-line therapy received treatment with temozolomide alone or combined with capecitabine (Xeloda, Roche). Temozolomide alone was given for 5 days every fourth week at 150 mg/m² (n=2) to 200 mg/m² (n=3). Temozolomide was administered in combination with capecitabine 1,000 mg twice daily (n=8) or 750 mg twice daily (n=11) on days 1 through 14 with temozolomide 150 mg/m² on days 10 through 14.

Bevacizumab (Avastin, Genentech/Roche) was administered to a subset of seven patients at 5 mg/kg on days 14 and 28 in 28-day cycles. Contrast-enhanced CT was performed at baseline and every second month. The researchers collected data retrospectively and analyzed tissue specimens for MGMT methylation.

The response rate was 33% (one complete response and seven partial responses) for a median duration of 19 months. After progression at inclusion, 38% of patients had stable disease with a median duration of 18 months. Median PFS was 6 months, and median OS was 22 months. MGMT methylation occurred in one patient.

“The treatment was well tolerated, without any severe side effects, and the patients could receive treatment mainly at home, all of which contributed to a good quality of life,” the researchers wrote. “Temozolomide can be given to patients with deteriorated renal function and may be a first-line option for patients unable to receive platinum combinations.”

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