From the Guidelines
XELOX (capecitabine and oxaliplatin) is not a preferred option for treating gastric neuroendocrine tumors (NETs). The treatment of gastric NETs depends on various factors such as tumor grade, stage, and type, and typically involves somatostatin analogs, surgical resection, or targeted therapies like everolimus or sunitinib as first-line therapies 1. Cytotoxic chemotherapy regimens, including those with platinum agents, are usually reserved for higher-grade or poorly differentiated neuroendocrine carcinomas. The provided evidence primarily discusses the treatment of gastric adenocarcinoma, with XELOX being a preferred regimen for advanced gastric cancers 1. However, the biological behavior and treatment approaches for NETs differ significantly from those for adenocarcinomas.
Some key points to consider when treating gastric NETs include:
- Tumor grade and stage
- Presence of functional symptoms
- Potential for surgical resection
- Role of targeted therapies
- Consideration of chemotherapy regimens with streptozocin, temozolomide, or platinum agents for higher-grade or progressive disease. Given the differences in treatment approaches, consultation with an oncologist specializing in neuroendocrine tumors is recommended to determine the most appropriate regimen for a gastric NET. The evidence provided does not support the use of XELOX as a first-line treatment for gastric NETs, and treatment decisions should be based on the specific characteristics of the tumor and the patient's overall condition 1.
From the Research
XELOX as an Option for Gastric Neuroendocrine Tumors (NET)
- XELOX, a combination of capecitabine and oxaliplatin, has been studied in various cancers, including gastric cancer and neuroendocrine tumors.
- In the context of gastric NET, the evidence suggests that XELOX can be an effective treatment option, particularly for well-differentiated NETs that have progressed after somatostatin analogues 2.
- A study published in 2007 found that XELOX was effective and tolerated in well-differentiated NETs, with an objective response rate of 30% and a biochemical response rate of 20% 2.
- While there is limited evidence specifically on the use of XELOX for gastric NET, the available data suggest that it can be a viable treatment option, especially when other treatments have failed.
- The efficacy and safety of XELOX have been demonstrated in other studies, including those on advanced gastric cancer, with response rates ranging from 39% to 42% 3, 4.
- However, it is essential to note that the treatment of gastric NET often requires a multidisciplinary approach, and the choice of therapy should be individualized based on the patient's specific needs and tumor characteristics.
Key Findings
- XELOX can be an effective treatment option for well-differentiated gastric NETs that have progressed after somatostatin analogues 2.
- The regimen has shown promise in advanced gastric cancer, with response rates ranging from 39% to 42% 3, 4.
- XELOX is generally well-tolerated, with manageable toxicity profiles 3, 2, 4.
- Further studies are needed to fully establish the role of XELOX in the treatment of gastric NET.