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The following is a summary of “Oxaliplatin-Based Versus Alkylating Agent in Neuroendocrine Tumors According to the O6 -Methylguanine-DNA Methyltransferase Status: A Randomized Phase II Study (MGMT-NET),” published in the November 2024 issue of Oncology by Walter et al.
Alkylating agents (ALKY) are standard chemotherapy for advanced neuroendocrine tumors (NETs), with O6-methylguanine-DNA methyltransferase (MGMT) status potentially influencing treatment response.
Researchers conducted a prospective study to compare the efficacy of ALKY and oxaliplatin in people with NETs based on the MGMT status.
They randomly assigned 105 people with advanced pancreatic, thoracic, or unknown primary NETs to receive either (ALKY, n = 62) or oxaliplatin (Ox, n = 43). The O6 -MGMT status was assessed using pyrosequencing (PSQ) and immunohistochemistry (H-score <50) when PSQ was not interpretable.
The results showed that the 3-month objective response rate (ORR) was 29.4% (10/34) for people with deficient MGMT (dMGMT) receiving ALKY vs. 8% (2/25) for those receiving Ox (OR = 3.5, 95% CI, 0.58-21.16, P=.172). The best ORR was 52.9% (18/34) for dMGMT people on ALKY vs. 11.5% (3/26) for those on Ox. Median PFS was longer in people with dMGMT on ALKY (14.6 months [95% CI, 7.2 to 22.1]) compared to Ox (11.3 months [9.4 to 13.2]).
They concluded that while the primary endpoint was not reached, ALKY showed clinical activity in people with deficient MGMT neuroendocrine tumors.
Source: ascopubs.org/doi/10.1200/JCO.23.02724
