# PRRT (177Lu-DOTATATE) with capecitabine and temozolomide (CAPTEM)

Source: https://nuclide.cc/pairings/prrt-plus-captem/  
Nuclide record `prrt-plus-captem` (Pairing). Data CC BY-NC 4.0, attribute "Data from Nuclide (nuclide.cc)"; commercial use needs a licence.

## TL;DR

For some pancreatic neuroendocrine tumours, doctors add two chemotherapy tablets (capecitabine and temozolomide) to the radioactive PRRT treatment. Trial data suggest the combination may control the pancreatic tumours for longer than either treatment alone, though it caused more blood-count side effects in one gut-tumour subgroup.

## Summary

The Australasian Gastrointestinal Trials Group CONTROL NET study (Pavlakis et al.) is a randomised, open-label phase 2 trial that tested 177Lu-octreotate PRRT combined with capecitabine plus temozolomide (CAPTEM) against PRRT alone (midgut NET cohort) or CAPTEM alone (pancreatic NET, pNET, cohort). Chemoradionuclide therapy is given on the premise that temozolomide's DNA-alkylating damage is potentiated by concurrent radiation, an approach analogous to the CAPTEM regimen already used as chemotherapy alone in NETs.

In the pNET cohort, PRRT/CAPTEM produced a numerically longer median progression-free survival (not reached versus 14 months for CAPTEM alone) and a higher objective response rate (44% versus 28%, and in an earlier interim readout 67% versus 33%). In the midgut NET cohort the two regimens performed similarly on the 15-month progression-free survival endpoint (90% for PRRT/CAPTEM versus 92% for PRRT alone), with a numerically higher objective response rate for the combination (31-34% versus 15-23%) but at the cost of roughly double the grade 3/4 haematological toxicity (88% versus 46%).

The trial's own conclusion is that CAPTEM/PRRT activity in pNETs is durable enough to justify phase 3 testing, while in midgut NETs the extra toxicity did not appear matched by extra benefit. This is consistent with a wider literature (systematic review, PMC9790144) reporting CAPTEM alone achieves roughly 77% disease control across NET subtypes, most convincingly in pancreatic disease, and with retrospective comparisons finding broadly similar progression-free survival between PRRT and CAPTEM given sequentially rather than together.

## Fields

- Kind: Pairing
- Last checked: 2026-09-22
- Tags: neuroendocrine tumours; chemoradionuclide therapy
- Pairs: Lutetium-177 dotatate + Capecitabine
- Type: combination
- Rationale: Temozolomide's DNA-alkylating damage is thought to be potentiated by concurrent radiation from PRRT, so combining CAPTEM chemotherapy with PRRT ('chemoradionuclide therapy') may increase response over either given alone.
- Evidence: AGITG CONTROL NET randomised phase 2 trial: in pancreatic NETs, PRRT/CAPTEM had a higher objective response rate than CAPTEM alone (44% vs 28%) and longer median PFS (not reached vs 14 months); in midgut NETs, 15-month PFS was similar (90% vs 92%) but grade 3/4 toxicity was roughly doubled with the combination (Pavlakis et al., ASCO 2022).

## Sources

- AGITG CONTROL NET final results (Pavlakis et al., ASCO 2022, J Clin Oncol 40:4122): https://ascopubs.org/doi/10.1200/JCO.2022.40.16_suppl.4122
- AGITG CONTROL NET midgut NET first results (ASCO 2020, J Clin Oncol 38:604): https://ascopubs.org/doi/10.1200/JCO.2020.38.4_suppl.604
- JONS-online summary of CONTROL NET pancreatic and midgut results: https://www.jons-online.com/special-issues-and-supplements/2020/2020-year-in-review-neuroendocrine-tumors/177lu-octreotate-prrt-temozolomide-capecitabine-in-pancreas-and-updated-midgut-nets
- Systematic review of CAPTEM in advanced NENs (PMC9790144): https://pmc.ncbi.nlm.nih.gov/articles/PMC9790144/

## Connected records

- indications: [Neuroendocrine tumours](https://nuclide.cc/indications/neuroendocrine/), [Pancreatic neuroendocrine tumours](https://nuclide.cc/indications/pancreatic-net/)
- drugs: [Capecitabine](https://nuclide.cc/drugs/capecitabine/), [Lutetium-177 dotatate](https://nuclide.cc/drugs/lutathera/), [Temozolomide](https://nuclide.cc/drugs/temozolomide/)
- technologies: [Peptide receptor radionuclide therapy (PRRT)](https://nuclide.cc/technologies/prrt/)
- people: [Jonathan R. Strosberg](https://nuclide.cc/people/jonathan-strosberg/)
- isotopes: [Lutetium-177](https://nuclide.cc/isotopes/lu-177/)

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