Looking for Synergy in Liver-Dominant Neuroendocrine Tumors

The addition of radioembolization to a mix of capecitabine (Xeloda) and temozolomide (Temodar) as radiosensitizing chemotherapy might enhance efficacy outcomes for sufferers with liver-dominant neuroendocrine tumors (NETs), in line with Michael C. Soulen, MD.

Soulen, director of Interventional Oncology on the Abramson Cancer Center on the University of Pennsylvania, spoke with CancerCommunity® on the 2025 North American Neuroendocrine Tumor Society (NANETS) Multidisciplinary NET Medical Symposium a couple of presentation he gave on the section 2 CapTemY90 trial (NCT04339036).^1,2 Providing some background for the trial, he initially defined that embolization-based combos have been used for liver-dominant NETs for over 50 years.

Then, Soulen expressed that though these combos are efficient and sturdy sufficient on their very own, a necessity to boost therapy outcomes persists. To that finish, he outlined issues for mixture therapies, suggesting that, at worst, combos might be wasted versus sequencing therapies. At finest, nonetheless, remedies may perform synergistically and ship outcomes which can be higher than the sum of their components.

In this trial, he defined, his staff evaluated radioembolization with radiosensitizing chemotherapy, which is already a regular mixture remedy for NETs, to try to realize that therapy synergy. He concluded by highlighting that this mix might assist deal with the first tumor and metastases concurrently, which might assist these with extra aggressive liver-dominant NET histologies.

Transcript:

We have been doing [liver-directed therapy] for sufferers with liver-dominant NETs for 50 years. Those remedies are usually both bland embolization, chemoembolization, or radioembolization, all of that are fairly efficient and fairly sturdy. But we’re at all times on the lookout for methods to make them higher, both make them [with a] larger response fee or extra sturdy. A really logical factor to do could be to mix our interventional therapies with a drug or a systemic remedy, the place the aim is synergy.

The downside of mixing 2 therapies directly is you’re firing 2 bullets. That might be unhealthy for the affected person within the sense that you just basically expended 1 extra bullet than you wanted and used a remedy which will have benefited them later in life for those who do them sequentially. When you mix 2 issues, the most probably consequence is you wasted one in every of them, partly. They might be additive, that means that you just get the advantage of each on the identical time, which might be okay, however the Holy Grail is synergy. Something the place you mix them, and they’re higher than the sum of the components.

In this explicit trial, we had been taking a look at radioembolization, a method the place we instill hundreds of thousands of little radioactive seeds into the liver that get embedded within the tumor. They radiate the tumor from the within out. Now, radiation oncologists, for years, have been doing what they name radiosensitizing chemotherapy. If you’re doing radiation remedy in your mind tumors, gastrointestinal [GI] tumors, [or] any form of tumor, they virtually at all times give a chemotherapy drug resembling capecitabine or temozolomide, that are recognized to make radiation work higher.

Capecitabine and temozolomide is a regular mixture remedy in NETs. The concept of mixing that with radioembolization developed very organically out of our tumor board. We had sufferers who had liver metastases, however additionally they had illness exterior the liver that the medical oncologist wished to deal with. They had a extra aggressive histology—possibly a excessive grade 2 or one thing the place we had been anxious—the place I wished to deal with the liver, [and] the medical oncologist wished to deal with every thing else. We stated, “Well, why don’t we do it together?”

References

1. Soulen MC, Iyer R, Berman Z, Chauhan A, Thornton L. Multicenter section 2 trial of Yttrium-90 radioembolization with capecitabine-temozolomide for grade 2 liver-dominant metastatic neuroendocrine tumors: interim report. Presented on the 2025 NANETS Multidisciplinary NET Medical Symposium; October 23-25, 2025; Austin, TX. Abstract 33445.
2. CapTemY90 for Grade 2/3 NET Liver Metastases (CapTemY90). ClinicalTrials.gov. Updated September 5, 2025. Accessed November 4, 2025.