Scott W. Savage, PharmD, MS, and Aimee Faso, PharmD, BCOP, CPP
The 2014 Gastrointestinal (GI) Cancers Symposium held in January 2014 highlighted 5 studies in its initial press release presenting new therapy options and improvements to existing treatments for a variety of GI related malignancies.1
CAPTEM (capecitebine [CAP] and temozolomide [TEM]) is a regimen investigated in an ongoing Phase II clinical trial targeting a new therapy option for advanced, well-differentiated neuroendocrine tumors (NETs). CAP, the prodrug for fluorouracil as a pyrimidine antimetabolite, and TEM, a prodrug with alkylation properties, shows synergistic qualities when used in combination for this therapy. Additionally, these new combination therapies of established oral oncolytics highlight a future engagement opportunity for specialty pharmacy in a class of neoplasms known to be challenging to therapy.2
Neuroendocrine Tumors and Therapy Approaches
NETs are classified according to organ origination, histology, and activity. Since the 1970s, the incidence of NETs has grown 4-fold, with approximately 8000 new diagnoses within the gastrointestinal area each year in the United States. The reason for the increase is unknown, but as with many other malignances it has been attributed to improved diagnosis and patient management within today’s health care environment.3
Common risk factors include behavioral risk factors (smoking, alcohol consumption, and nutrition), genetic/medical risk factors (family history of cancer and diabetes), and occupational factors.4
Treatment of NETs depends on tumor site, tumor stage, and patient symptoms.5
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Image of gastric neuroencrine tumor courtesy of wikimedia commons.