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Home > Neuroendocrine tumour Advanced - capecitabine and temozolomide [TWICE daily dosing for use with PRRT]

Neuroendocrine tumour Advanced - capecitabine and temozolomide [TWICE daily dosing for use with PRRT]

Treatment Overview

Dosing of capecitabine and temozolomide in this regimen is for use when PRRT (peptide receptor radionuclide therapy) is given concurrently on day 10 of the 8-week (56-day) cycle.

For PRRT regimens see:

  • Neuroendocrine tumour Advanced - peptide receptor radionuclide therapy [PRRT] for pheochromocytoma/paraganglioma, or 
  • Neuroendocrine tumour Advanced - peptide receptor radionuclide therapy [PRRT] for gastroenteropancreatic [GEP].

For those not undergoing PRRT, see alternate capecitabine and temozolomide regimens:

  • Neuroendocrine tumour Advanced - capecitabine and temozolomide [TWICE daily dosing], or 
  • Neuroendocrine tumour Advanced - capecitabine and temozolomide [ONCE daily dosing].

Cycles 1 to 4 - 56 days

Cycle length:
56

capecitabine: Some clinicians may consider dose capping of capecitabine to 2500 mg total dose per day for patients with high BSA.

Cycle details

Cycles 1 to 4 - 56 days

Medication Dose Route Days Max Duration
capecitabine * 750 mg/m² Twice daily oral administration 1 to 14
ondansetron 8 mg Twice daily oral administration 10 to 14
temozolomide * 75 mg/m² Twice daily oral administration 10 to 14
domperidone 10 mg Three times daily oral administration 1
loperamide 2 mg oral administration 1
docusate sodium + sennoside B 2 Tablet(s) Twice daily oral administration 10 to 14

capecitabine: Some clinicians may consider dose capping of capecitabine to 2500 mg total dose per day for patients with high BSA.

Full details

Cycles 1 to 4 - 56 days

Day: 1

Medication Dose Route Max duration Details
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.
domperidone 10 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.
loperamide 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) at onset of loose bowel motions and a further ONE capsule (=2 mg) for every loose bowel motion (maximum of EIGHT capsules in 24 hours), or use as directed by oncologist or haematologist.

Day: 2

Medication Dose Route Max duration Details
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 3

Medication Dose Route Max duration Details
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 4

Medication Dose Route Max duration Details
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 5

Medication Dose Route Max duration Details
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 6

Medication Dose Route Max duration Details
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 7

Medication Dose Route Max duration Details
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 8

Medication Dose Route Max duration Details
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 9

Medication Dose Route Max duration Details
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 10

Medication Dose Route Max duration Details
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.
ondansetron 8 mg Twice daily oral administration
Instructions:

ONE hour prior to temozolomide.
temozolomide * 75 mg/m² Twice daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
docusate sodium + sennoside B 2 Tablet(s) Twice daily oral administration
Instructions:

When required for constipation.

  • Each tablet contains docusate sodium 50 mg + sennoside B 8 mg.

Day: 11

Medication Dose Route Max duration Details
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.
ondansetron 8 mg Twice daily oral administration
Instructions:

ONE hour prior to temozolomide.
temozolomide * 75 mg/m² Twice daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
docusate sodium + sennoside B 2 Tablet(s) Twice daily oral administration
Instructions:

When required for constipation.

  • Each tablet contains docusate sodium 50 mg + sennoside B 8 mg.

Day: 12

Medication Dose Route Max duration Details
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.
ondansetron 8 mg Twice daily oral administration
Instructions:

ONE hour prior to temozolomide.
temozolomide * 75 mg/m² Twice daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
docusate sodium + sennoside B 2 Tablet(s) Twice daily oral administration
Instructions:

When required for constipation.

  • Each tablet contains docusate sodium 50 mg + sennoside B 8 mg.

Day: 13

Medication Dose Route Max duration Details
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.
ondansetron 8 mg Twice daily oral administration
Instructions:

ONE hour prior to temozolomide.
temozolomide * 75 mg/m² Twice daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
docusate sodium + sennoside B 2 Tablet(s) Twice daily oral administration
Instructions:

When required for constipation.

  • Each tablet contains docusate sodium 50 mg + sennoside B 8 mg.

Day: 14

Medication Dose Route Max duration Details
capecitabine * 750 mg/m² Twice daily oral administration
Instructions:
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.
ondansetron 8 mg Twice daily oral administration
Instructions:

ONE hour prior to temozolomide.
temozolomide * 75 mg/m² Twice daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
docusate sodium + sennoside B 2 Tablet(s) Twice daily oral administration
Instructions:

When required for constipation.

  • Each tablet contains docusate sodium 50 mg + sennoside B 8 mg.

Supportive Care Factors

Factor Value
Constipation risk: laxatives are usually prescribed
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment
Emetogenicity: Variable
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis may be considered

Emetogenicity:

  • MINIMAL to LOW days 1 to 9 (capecitabine only). Routine antiemetic premedication is not usually required; an individualised approach is appropriate. 
  • MEDIUM to HIGH days 10 to 14 (temozolomide). Routine antiemetic premedication may initially be required; an individualised approach is appropriate.

References

Nick Pavlakis, David Turner Ransom, David Wyld, et al. Australasian Gastrointestinal Trials Group (AGITG) CONTROL NET Study: 177Lu-DOTATATE peptide receptor radionuclide therapy (PRRT) and capecitabine plus temozolomide (CAPTEM) for pancreas and midgut neuroendocrine tumours (pNETS, mNETS)—Final results.DOI: 10.1200/JCO.2022.40.16_suppl.4122 Journal of Clinical Oncology 40, no. 16_suppl (June 01, 2022) 4122-4122.

Yordanova A, Ahmadzadehfar H. Combination Therapies with PRRT. Pharmaceuticals (Basel). 2021 Sep 30;14(10):1005. doi: 10.3390/ph14101005., PMID: 34681229

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.