Abstract No. 356 - Cryoablation as local therapy for patients with bone metastatic breast cancer

Abstract

No. 355 Feasibility of combining capecitabine and temozolomide with yttrium 90 radioembolization (CapTemY90) for intermediate grade neuroendocrine tumors M.C. Soulen, G. Deitrick, D. van Houten, S. W. Stavropoulos, U. Teitelbaum, B. Giantonio; Radiology, University of Pennsylvania, Philadelphia, PA; Medical Oncology, University of Pennsylvania, Philadelphia, PA Purpose: Grade 2 neuroendocrine tumors (NETs) have an intermediate proliferative rate and progress more aggressively than low-grade NETs. The combination of capecitabine and temozolomide (CapTem) has been shown to achieve response rates of 61% in well-differentiated NETs (ref). Capecitabine is synergistic with radiation. We investigated the safety and tolerability of combining CapTem with Y90 radioembolization for progressive Grade 2 NETs with liver-dominant metastases. Materials and Methods: We retrospective analysed patients treated with capecitabine 600 mg/m2 twice daily for 14 days, temozolomide 150-200 mg/m2 in two divided doses on days 1014, and yttrium 90 radioembolization. Angiography and MAA scan for Y90 planning were performed during the first cycle of chemotherapy. During the second cycle, Y90 radioembolization with resin microspheres was performed to one lobe on Day 7. The other lobe was treated if needed on Day 7 of the 4th cycle. CapTem was continued in monthly cycles. Toxicities were assessed monthly. Imaging was performed very 3 months after the first radioembolization. Results: 8 patients have been treated. Primary NETs were pancreatic (3), bronchial (2), rectal (2), and duodenal. Prior therapy included Sandostatin (7), systemic chemotherapy(4), surgery (4), ablation (1), chemoembolization (1), and radioembolization (1). 7/8 patients completed the prescribed course of chemotherapy and radioembolization. One previously radioembolized patient developed Grade 2 hyperbilirubinemia after the first radioembolization of the current cycle and did not have the other lobe treated. 3 patients had dose interruptions for Grade 2-3 thrombocytopenia or fatigue. There were no Grade 4 toxicities. 4 patients have had 3-month imaging, all with partial response in the treated liver. Conclusion: This novel integration of systemic therapy with liver radioembolization is safe and tolerable, with toxicities similar to those reported for CapTem alone. Early responses are encouraging and supports further evaluation. Reference 1. Fine RL, et al. Capecitabine and temozolomide (CAPTEM) for metastatic, well-differentiated neuroendocrine tumors: The Pancreas Center at Columbia University experience. Cancer Chemother Pharmacol 2013; 71:663–670.