There are few hard and fast rules for the medical treatment of patients with metastatic pancreatic neuroendocrine tumors. Two agents which have shown promise include everolimus (Afinitor ~ Novartis) and temozolomide (Temodar ~ Merck).
An article by Kulke and colleagues at Harvard Medical School and the associated Dana-Farber Cancer Institute in Boston as published in the September 2013 issue of the journal Cancer offers the results of a phase I/II clinical trial for a regimen consisting of a combination of the drug agents everolimus and temozolomide for the treatment of advanced neuroendocrine tumors.
In this study, 43 patients with diagnosed metastatic neuroendocrine tumors were given this regimen in two cohorts, and with an escalation of temozolomide dosage after safeties were observed. The progression-free survival median for patients was found to be 15.4 months. The overall median survival point was not reached. The temozolomide treatment was limited to a total duration of six months.
The authors suggest that the toxicity profile appeared to be reasonable. And thus, with apparent activity and tolerable side-effects, the everolimus and temozolomide combination may be appropriate for the treatment of advanced neuroendocrine tumors, and certainly merits further investigation including trying to discover whether the regimen improves survival over the use of each agent alone.
Dale O’Brien, MD