Is XELOX (oxaliplatin and capecitabine) an option for neuroendocrine tumors (NETs)?

From the Guidelines

XELOX (oxaliplatin and capecitabine) may be considered as an alternative treatment option for neuroendocrine tumors (NETs), particularly for progressive pancreatic NETs, as suggested by the combination of irinotecan and cisplatin or FOLFOX chemotherapy being an alternative 1.

Key Considerations

• The standard treatment for neuroendocrine carcinoma (grade 3) is cisplatin and etoposide, with a response rate of 42–67% and a duration of 8 to 9 months 1.
• Systemic chemotherapy based on streptozotocin (STZ) is considered a standard therapy for progressive pancreatic NETs with low or moderate proliferative capacity, with combinations of STZ and 5-fluorouracil and/or doxorubicin leading to partial remission rates of 35–40% 1.
• Recent phase II studies have shown efficacy of temozolomide-based chemotherapy either with antiangiogenic drugs or capecitabine 1.
• Molecular targeted therapies, such as sunitinib and everolimus, have been shown to be effective in treating NETs, with everolimus leading to a prolongation of progression-free survival (PFS) by 6.4 months compared to placebo 1.

Treatment Options

• Somatostatin analogs (octreotide or lanreotide) are commonly used for well-differentiated NETs.
• Targeted therapies (everolimus or sunitinib) are effective for advanced pancreatic NETs.
• Peptide receptor radionuclide therapy (PRRT) may be considered for certain patients.
• Chemotherapy regimens like temozolomide plus capecitabine (CAPTEM) or streptozocin-based combinations may be used for progressive pancreatic NETs.

Individualized Treatment

• The choice of treatment depends on tumor grade, primary site, disease extent, and growth rate.
• NETs are heterogeneous tumors with varying biological behaviors, and treatment should be individualized based on tumor characteristics and patient factors.
• Patients with NETs should ideally be managed by a multidisciplinary team with experience in neuroendocrine tumors to determine the most appropriate treatment strategy.

From the Research

XELOX as an Option for Neuroendocrine Tumors (NETs)

• XELOX, a combination of oxaliplatin and capecitabine, has been evaluated as a treatment option for NETs in several studies 2, 3.
• A study published in 2007 found that XELOX was effective and tolerated in well-differentiated NETs after progression following somatostatin analogues, with objective response rates of 30% and stable disease rates of 48% 2.
• Another study published in 2013 found that the combination of capecitabine and oxaliplatin (CapOx) was an effective treatment option for advanced NETs, with a partial response rate of 29% and a median time to progression of 9.8 months 3.
• While XELOX has shown promise in the treatment of NETs, its use is not limited to this type of cancer, and it has also been evaluated as a treatment option for other types of cancer, such as colorectal cancer 4, 5.

Efficacy and Safety of XELOX in NETs

• The efficacy and safety of XELOX in NETs have been evaluated in several studies, with results suggesting that it is a viable treatment option for patients with advanced NETs 2, 3.
• The most common adverse events associated with XELOX in NETs include neuropathy, diarrhea, and lethargy, although these events are generally manageable and reversible 2, 3.
• The use of XELOX in NETs may be limited by the availability of other treatment options, such as somatostatin analogues and targeted therapies, although it may be considered as a second-line or subsequent treatment option for patients who have progressed on other therapies 6.

Comparison with Other Treatment Options

• XELOX has been compared with other treatment options for NETs, including somatostatin analogues and targeted therapies, although direct comparisons are limited 6.
• The choice of treatment for NETs depends on several factors, including the type and grade of the tumor, the presence of symptoms, and the patient's overall health status 6.
• Further studies are needed to fully evaluate the efficacy and safety of XELOX in NETs and to determine its place in the treatment paradigm for this type of cancer 2, 3.