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“This high-risk cohort requires escalated therapy to improve oncologic outcomes. The ongoing SWOG study is investigating the use of CAPTEM to enhance outcomes for these patients.

Brett L. Ecker, MD, surgical oncologist, assistant professor in the Department of Surgery, Division of Surgical Oncology, and Section of Gastrointestinal Oncology at the Rutgers Robert Wood Johnson Medical School, discusses the potential role of capecitabine and temozolomide (CAPTEM) in the treatment of pancreatic neuroendocrine tumors (pNETs), particularly in patients with high-risk or recurrent disease.

Ecker notes that CAPTEM’s cytotoxic properties demonstrated efficacy in metastatic settings that have paved the way for its investigation as an adjuvant therapy to address micrometastatic disease in patients with pNETs. The phase 2 ECOG 2211 trial (NCT01824875) confirmed CAPTEM’s ability to improve progression-free survival (PFS) in metastatic disease, providing a strong rationale for its application in earlier disease settings, Ecker explains.

Building on this evidence, the ongoing SWOG S2104 trial (NCT05040360) aims to evaluate CAPTEM’s ability to reduce recurrence in patients with moderate- or high-risk features following pNET resection, he says.

The trial utilizes the Zaidi risk score, which stratifies patients into low-, moderate-, and high-risk categories based on recurrence probabilities, Ecker notes. Data indicate that moderate-risk patients have a 20% recurrence risk at 5 years, while high-risk patients face nearly a 100% recurrence risk at three years.

Ecker explains that these findings highlight the unmet need for therapeutic escalation in these populations. CAPTEM’s ability to target micrometastatic disease makes it a promising candidate to improve outcomes for these high-risk patients, he adds.

The SWOG trial’s focus on CAPTEM’s efficacy in the adjuvant setting could provide critical insights into its potential to transform the treatment paradigm for pNETs, Ecker continues. By combining capecitabine and temozolomide, the regimen leverages the synergistic effects of these agents to achieve enhanced cytotoxicity and tumor control, he explains.

Ecker notes that the SWOG trial represents a critical step toward integrating CAPTEM into routine care for pNETs, particularly for patients with high recurrence risk. If successful, the trial could establish CAPTEM as a standard adjuvant therapy, providing patients with a viable option to reduce recurrence and improve long-term outcomes, Ecker concludes.

Videos

Dr Ecker on the Role of CAPETEM in the Treatment of Pancreatic NETs

Dr Ecker on the Investigation of the Microbiome in Pancreatic Cancer

Brett L. Ecker, MD, surgical oncologist, member of RWJBarnabas Health Medical Group, Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, discusses the evaluation of the microbiome in pancreatic cancer, highlighting remaining questions and future steps for research.

Rutgers Cancer Institute of New Jersey's Annual Oncology Clinical Practice and Research Summit

, Ecker presented foundational data supporting his ongoing pilot study on the pancreas microbiome. This research investigated how microbes within pancreas cysts might play a role in propelling dysplastic progression along the continuum, spanning from low-grade to high-grade dysplasia and eventually invasive cysts, he begins. The goal of this research is to discern, through the interplay between microbes and the epithelial, stromal, and immune compartments, potential targets to impede this progression, Ecker states.

Recent evidence has challenged the traditional notion of the pancreas is a sterile organ, revealing that, particularly in cancer contexts, microbes are often present, typically identified within tumoral cells, he expands. The association of these microbes with altered gene expression linked to metastatic spread and tumor growth prompts the question: are these microbes present in precursor lesions for pancreas cancer? Further questions focus on determining their presence, quantifying them across the dysplastic continuum, identifying species, and assessing microbial diversity, Ecker emphasizes. Moreover, further research should identify how these microbes affect cellular processes. This area of microbial research is relatively nascent, with advancements in technology over the past few years facilitating exploration, he notes.

In collaboration with the Karolinska Institute, Ecker has identified certain onco-bacteria, typically part of the oral microbiota, associated with high-grade dysplasia compared with low-grade dysplasia. To date, Ecker and his group are among the few to publish on this aspect, and anticipate contributing further to the burgeoning field of microbial research in the context of pancreas cancer.

Brett L. Ecker, MD, discusses the evaluation of the microbiome in pancreatic cancer, highlighting remaining questions and future steps for research.


Brett L. Ecker, MD

Articles

Dr Ecker on the Role of CAPETEM in the Treatment of Pancreatic NETs

Dr Ecker on the Investigation of the Microbiome in Pancreatic Cancer