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DOI: 10.1055/s-0043-1765587
Efficacy and safety of capecitabine and temozolomide (CAPTEM) in advanced gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NEN): a systematic review and metanalysis
Aims The combination of capecitabine and temozolomide (CAPTEM) is increasingly used for advanced gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NEN), but evidence on results is sparse.We conducted a systematic review and meta-analysis to assess efficacy and safety of CAPTEM in advanced GEP-NEN
Methods We included studies enrolling patients with any grade GEP-NENs undergoing CAPTEM. A meta-analysis with random effects model, progression-free survival (PFS) as primary endpoint and severe adverse events (SAEs) rate as secondary endpoint was performed. The heterogeneity (I2) was interpreted by metaregression analysis considering the following covariates: study type and design, sample size, metastatic disease rate, rate of primary pancreatic NENs, previous treatments, and study quality.
Results A total of 22 studies with 788 patients were included. All but 1 study, being a RCT, were retrospective. The median CAPTEM cycles number was 6.9 (IQR 4.5-8). The cumulative PFS was 14.7 months (12.9-16.5), with high heterogeneity (I2=99%). Study type and design, previous treatments, and quality of the studies did not affect PFS. Although not significant, PFS was higher in patients with nonpancreatic primary tumors and in post-2017 trials. The pooled SAEs rate was 17.6% (10.1-25). There was no publication bias.
Conclusions CAPTEM is an effective combination, with similar PFS and a safety profile compared to other agents. Further investigation in RCTs or in sequence studies is advisable
Publication History
Article published online:
14 April 2023
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