Safety and Feasibility of Integrating Yttrium-90 Radioembolization With Capecitabine-Temozolomide for Grade 2 Liver-Dominant Metastatic Neuroendocrine Tumors

Soulen, Michael C.; Houten, Diana van; Teitelbaum, Ursina R.; Damjanov, Nevena; Cengel, Keith A.; Metz, David C.

doi:10.1097/mpa.0000000000001115

Cited by 21 publications

(11 citation statements)

References 14 publications

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“…In total, prophylaxis was only used in 20.1% of the whole population (1,116/5,545). The employed prophylaxis included octreotide therapy (13 studies) [39, 61, 64, 65, 83, 92, 100, 102, 104, 111, 122, 128, 129] and somatostatin analogues (not specified; 2 studies) [99, 132]; however, in 86 studies, prophylaxis details were not reported.…”

Section: Resultsmentioning

confidence: 99%

Liver Embolisation for Patients with Neuroendocrine Neoplasms: Systematic Review

Kanabar

Barriuso

McNamara³

et al. 2020

Neuroendocrinology

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Background: Liver embolisation is one of the treatment options available for patients diagnosed with neuro-endocrine neoplasms (NEN). It is still uncertain whether the benefits of the various types of embolisation treatments truly outweigh the complications in NENs. This systematic review assesses the available data relating to liver embolisation in patients with NENs. Methods: Eligible studies (identified using MED-LINE-PubMed) were those reporting data on NEN patients who had undergone any type of liver embolisation. The primary end points were best radiological response and symptomatic response; secondary end-points included progression-free survival (PFS), overall survival (OS) and toxicity. Results: Of 598 studies screened, 101 were eligible: 16 were prospective (15.8%). The eligible studies included a total of 5,545 NEN patients, with a median of 39 patients per study (range 5-214). Pooled rate of partial response was 36.6% (38.9% achieved stable disease) and 55.2% of patients had a symptomatic response to therapy when pooled data were analysed. The median PFS and OS were 18.4 months (95% CI 15.5-21.2) and 40.7 months (95% CI 35.2-46.2) respectively. The most common toxicities were found to be abdominal pain (48.8%) and nausea (48.1%). Outcome did not significantly vary depending on the type of embolisation performed. Conclusion: Liver embolisation provides adequate symptom relief for patients with carcinoid syndrome and is also able to reach partial response in a significant proportion of patients and a reasonable PFS. Quality of studies was limited, highlighting the need of further prospective studies to confirm the most suitable form of liver embolisation in NENs.

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Section: Resultsmentioning

confidence: 99%

Liver Embolisation for Patients with Neuroendocrine Neoplasms: Systematic Review

Kanabar

Barriuso

McNamara³

et al. 2020

Neuroendocrinology

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“…There are early phase 1 and 1b data on combining SIRT with everolimus and pasireotide, 75 and capecitabine-temozolomide. 76 These combination therapies hold promise and have so far proven safety. King et al 77 prospectively studied a combination of TARE and 7-day systemic infusion of 5-fluorouracil as a radiosensitizer in 34 patients with progressive NETLMs.…”

Section: Combination With Chemotherapymentioning

confidence: 99%

Radioembolization for Metastatic Neuroendocrine Tumors

El-Haddad

Strosberg

2021

Digestive Disease Interventions

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Transarterial radioembolization (TARE) using β-emitting yttrium-90 microspheres has been used for decades in patients with liver-dominant unresectable metastatic neuroendocrine tumors (mNETs). TARE is one of the embolotherapies supported by the National Comprehensive Cancer Network, among other guidelines, for progressive or symptomatic liver-dominant mNETs. Initial studies with relatively short-term follow-up have indicated that TARE is likely to be at least as effective in controlling symptoms and/or disease progression in the liver as bland or chemoembolization. However, more recent data have shed new light on the risk of long-term hepatotoxicity in patients with mNETs treated with TARE. In this article, we will discuss rationale for TARE, clinical indications, outcomes, and toxicity, as well as new strategies to enhance efficacy of TARE while reducing its toxicity in the treatment of liver-dominant mNETs.

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“…Y90 administration was performed on the dominant lobe on day 7 of the second cycle, with the remaining lobe treated on day 7 of the third or fourth cycle in patients with bilobar disease. 41 A median of eight cycles of chemotherapy were administered per patient, with nine patients requiring dose reductions or interruptions, and eight patients requiring eventual treatment cessation due to toxicities. Adverse events were additive, relative to known toxicity profiles for Y90 and capecitabine/temozolomide as individual therapies.…”

Section: Systemic Chemotherapymentioning

confidence: 99%

“…However, oncologic outcomes indicated synergy, and a proposed phase 2 trial aims to further investigate this treatment combination. 41…”

Section: Systemic Chemotherapymentioning

confidence: 99%

Radioembolization in the Setting of Systemic Therapies

Mabud

Hickey

2021

Semin intervent Radiol

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90Yttrium (Y90) radioembolization has been shown to improve outcomes for primary and metastatic liver cancers, but there is limited understanding of the optimal timing and safety of combining systemic therapies with Y90 treatment. Both therapeutic effects and toxicities could be synergistic depending on the timing and dosing of different coadministration paradigms. In particular, patients with liver-only or liver-dominant metastatic disease progression are often on systemic therapy when referred to interventional radiology for consideration of Y90 treatment. Interventional radiologists are frequently asked to offer insight into whether or not to hold systemic therapy, and for how long, prior to and following transarterial therapy. This study reviews the current evidence regarding the timing and safety of systemic therapy with Y90 treatment for hepatocellular carcinoma, metastatic colorectal carcinoma, intrahepatic cholangiocarcinoma, metastatic neuroendocrine tumors, and other hepatic metastases. A particular focus is placed on the timing, dosing, and toxicities of combined therapy.

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Safety and Feasibility of Integrating Yttrium-90 Radioembolization With Capecitabine-Temozolomide for Grade 2 Liver-Dominant Metastatic Neuroendocrine Tumors

Abstract: CapTemY90 is feasible and safe for grade 2 NETs. Toxicities were additive. Oncologic outcomes suggest synergy.

Cited by 21 publications

References 14 publications

Liver Embolisation for Patients with Neuroendocrine Neoplasms: Systematic Review

Liver Embolisation for Patients with Neuroendocrine Neoplasms: Systematic Review

Radioembolization for Metastatic Neuroendocrine Tumors

Radioembolization in the Setting of Systemic Therapies

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