Downstaging of a gastroenteropancreatic neuroendocrine tumor after combination therapy of temozolomide, Bevacizumab and long-acting somatostatin analogs

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Introduction: Patients with gastroenteropancreatic endocrine (GEP) tumors and progressive disease have been treated with several chemotherapeutic regimens with variable responses and considerable toxicity. Recent studies have shown that GEP tumors may respond to therapy with anti-angiogenic agents, mainly as a result of their increased vascularity.

Aim(s): Description of the efficacy and change of therapeutic approach of concomitant administration of an alkylatic agent temozolomide, with the monoclonal antibody against VEGF, bevacizumab, along with the long-acting somatostatin analog in a patient with a inoperable GEP tumor.

Materials and methods: We describe a 75-year-old male patient who was found, using abdominal computerized tomography, to have an eight cm GEP tumor originating from either the stomach or the duodenum, encasing the whole duodenum and pancreas and compressing the liver. There was no other evidence of disease dissemination. Scintigraphy with 111In-octreotide demonstrated moderate uptake. An unsuccessful attempt was made initially to remove the tumor. Histology revealed a well-differentiated GEP tumor exhibiting 4 mitoses/OF and a Ki-67 proliferative index (PI) of 10%. The patient was treated with six cycles of combination treatment including: temozolomide 100mg/daily orally, intravenous bevacizumab 7.5mg/m2/3 weeks, and 30 mg of octreotide LAR/four weeks (ΤeBeSa). During treatment, he developed grade 1 nausea that was successfully managed with metoclopramide tablets.

Conference: 7th Annual ENETSConcerence (2010)

Presenting Author: KALTSAS G

Authors: Antoniou S, Kanakis G, Zilos A, Thomas D, Tzavaris N,

Keywords: GEPNETs, temozolomide, bevacizumab, somatostatin analogue,