Outcomes of temozolomide and capecitabine chemotherapy used in neuroendocrine and endocrine tumours: A real-world comparison of treatment evidence in Alberta, Canada, from 2011-2021.
Notice bibliographique
Résumé
e23064 Background: Capecitabine and temozolomide (CAPTEM) have proven effective in improving progression-free survival (PFS) in pancreatic neuroendocrine tumors (PNETs). This study extends its evaluation to determine efficacy across the broader spectrum of neuroendocrine and endocrine tumors (NETs and ETs) Methods: This was a retrospective cohort study, for which REB approval was obtained. We identified all patients with NETs & ETs treated with CAPTEM (at least 1 cycle) in Alberta from 2011-2021. PFS & OS from start of CAPTEM were compared between groups stratified by primary: Pancreatic NETs (PNETs); gastrointestinal NETs (GINETs); Pulmonary NETs (PuNET); other NETs (ONETs). Among 159 patients identified, there were 67 PNETs, 38 GINETs, 35 PuNETs, & 19 ONETs. PFS & OS were compared between NETs when CAPTEM was used as 1st vs. later-line therapy & patients receiving ≥ 6 vs. < 6 cycles. Kaplan-Meier & Log- Rank tests were used, adjusted for age & sex using cox regression. Results: Compared to PNETs, GINETs demonstrated no statistically significant difference in median progression-free survival (PFS 10.5 vs 9 m, p = 0.11; HR = 1.14 95%CI = 0.76-1.71; HR adjusted for age & sex = 1.10, 95% CI = 0.79 -1.65) and overall survival (OS median 15.9 vs 19 months, p = 0.15; HR = 1.13 , 95% CI = 0.69 -1.85, HR adjusted to age and sex = 1.11 , 95% CI = 0.69 - 1.81). Conversely, PuNETs & ONETs were associated with significantly lower median PFS (PuNETs 3 vs 9m, p = 0.02, HR = 1.6 95%CI = 1.1 -2.4, HR adjusted for age & sex = 1.65, 95% CI = 1.15 - 2.5); ONETs 2 vs 9m, p = 0.01, HR = 1.56 95%CI = 1.1 -2.6, HR adjusted for age &sex = 1.59, 95% CI = 1.14 -2.7) and OS (PuNETs 6.8 vs 19 m, p = 0.01, HR = 1.7, 95% CI = 1.06 - 2.7, HR adjusted to age & sex = 1.73, 95% CI = 1.08 to 2.71); ONETs 5.6 vs 19 m, p = 0.02, HR = 1.49, 95% CI = 1.1 - 2.7, HR adjusted to age and sex = 1.51, 95% CI = 1.05 - 2.8). OS analyses revealed comparable trends.CAPTEM therapy administered as 1st-line treatment was associated with longer median PFS & OS compared to later-line use. PFS (10 vs 3.5m, P = .008; HR = 0.56 95% CI = 0.40 -0.78) & OS (23 vs 4.7m, P = 0.0001; HR = 0.42 95% CI = 0.29 -0.62). Additionally, patients receiving ≥6 cycles of CAPTEM exhibited higher median PFS and OS compared to those receiving < 6 cycles. PFS (18 vs 2m, P = 0.0001; HR = 0.22 95%CI = 0.16 - 0.32) & OS (29 vs 4.2m, P = 0.0001; HR = 0.22 95% CI = 0.14 - 0.34). Conclusions: CAPTEM therapy demonstrates comparable efficacy in gastrointestinal NETs (GINETs) to that observed in pancreatic NETs (PNETs) but appears to be less effective in non- gastroenteropancreatic NETs and Endocrine tumors. Importantly, the use of CAPTEM as a first- line treatment and the administration of an extended cycle regimen are significantly associated with improved progression free survival (PFS) and overall survival (OS) across the broader NET spectrum, representing a novel prognostic variable not previously reported.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,014 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,006 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».