Smitha Krishnamurthi, MD, a medical oncologist and associate professor of medicine at University Hospitals Case Medical Center and Case Western Reserve University, discusses a prospective phase II study of capecitabine and temozolomide (CAPTEM) for progressive, moderately, and well-differentiated metastatic neuroendocrine tumors.

Krishnamurthi says neuroendocrine tumors are typically resistant to chemotherapy because they are slow growing. Preclinical data found that giving capecitabine followed by temozolomide depletes thymidine in patients. Thymidine inhibits the ability of cells to repair the damage caused by temozolomide, Krishnamurthi says.

In the phase II prospective study, 28 patients with neuroendocrine tumors were treated with the CAPTEM combination. Of the 12 patients with carcinoid tumors, 5 patients showed a partial or complete response to the therapy. Patients with pituitary tumors and about 33% of patients with pancreatic neuroendocrine tumors also responded to treatment.

Progression-free survival for these patients was close to 2 years, Krishnamurthi says. However, further studies are needed to test the efficacy of CAPTEM in neuroendocrine tumors.

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Dr. Krishnamurthi on CAPTEM as Treatment for Neuroendocrine Tumors

Smitha Krishnamurthi, MD, a medical oncologist and associate professor of medicine at University Hospitals Case Medical Center and Case Western Reserve University, discusses the results of the phase III RAINBOW trial that explored ramucirumab plus paclitaxel as a second-line treatment in gastric cancer.

Ramucirumab is an antibody against VEGFR-2. In this randomized, phase III study, patients received paclitaxel chemotherapy with or without ramucirumab, Krishnamurthi says. The patients enrolled in the study received a first-line platinum- and fluoropyrimidine-based regimen.

Krishnamurthi says the trial achieved its primary endpoint by proving that the addition of ramucirumab improves overall survival (OS). The median OS for patients who received ramucirumab plus chemotherapy was 9.7 months compared with 7.4 months for paclitaxel alone.

The study also showed that the response rate was increased with ramucirumab and paclitaxel as second-line therapy. Krishnamurthi says the response rate was 28%, a high response rate for second-line therapy in gastric cancer. There was also an improvement of quality of life in the ramucirumab/paclitaxel arm.

View more from the 2014 GI Cancers Symposium

Smitha Krishnamurthi, MD, discusses the results of the RAINBOW TRIAL

Smitha Krishnamurthi, MD

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Dr. Krishnamurthi on CAPTEM as Treatment for Neuroendocrine Tumors

Dr. Smitha Krishnamurthi on the Phase III RAINBOW Trial