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RecruitingNCT05040360Updated Dec 15, 2025

Testing the Use of Chemotherapy After Surgery for High-Risk Pancreatic Neuroendocrine Tumors

A Phase 2 interventional study of Capecitabine and Temozolomide in Metastatic Malignant Neoplasm in the Liver, Pancreatic Neuroendocrine Tumor and Stage I Pancreatic Neuroendocrine Tumor AJCC v8, sponsored by SWOG Cancer Research Network. Recruiting at 448 sites in 3 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-12-15.

Sponsored by SWOG Cancer Research Network · Phase 2, Interventional, and Treatment

From the registry’s dates

  • Started May 2022; still recruiting 4 years 6 months later.
Phase
Phase 2
Study type
Interventional
Enrollment
141
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

This phase II trial studies the effect of capecitabine and temozolomide after surgery in treating patients with high-risk well-differentiated pancreatic neuroendocrine tumors. Chemotherapy drugs, such as capecitabine and temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving capecitabine and temozolomide after surgery could prevent or delay the return of cancer in patients with high-risk well-differentiated pancreatic neuroendocrine tumors.

Read the detailed description

PRIMARY OBJECTIVE:

I. To evaluate recurrence-free survival (RFS) in participants with resected pancreatic neuroendocrine tumors (pNETs) randomized to treatment with capecitabine + temozolomide (CAPTEM) compared to observation only.

SECONDARY OBJECTIVES:

I. To evaluate overall survival (OS) in participants randomized to treatment with CAPTEM compared to observation only.

II. To evaluate the safety and tolerability of CAPTEM compared to observation only.

BANKING OBJECTIVE:

I. To bank specimens for future correlative studies.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM I: Patients receive capecitabine orally (PO) twice daily (BID) on days 1-14 and temozolomide PO once daily (QD) on days 10-14. Treatment repeats every 28 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.

ARM II: Patients undergo surveillance with no active treatment.

After completion of study treatment, patients are followed up every 6 months for 3 years and then annually until 5 years from randomization.

02

Conditions studied

  • Metastatic Malignant Neoplasm in the Liver
  • Pancreatic Neuroendocrine Tumor
  • Stage I Pancreatic Neuroendocrine Tumor AJCC v8
  • Stage II Pancreatic Neuroendocrine Tumor AJCC v8
  • Stage III Pancreatic Neuroendocrine Tumor AJCC v8

Browse trials for

03

In context

Adenoma, Islet Cell

113 studies on the registry are indexed under Adenoma, Islet Cell; 30 are open to participants now.

This study's planned enrollment of 141 is above the median of 38 across 76 interventional studies indexed under Adenoma, Islet Cell.

Browse Adenoma, Islet Cell studies →

Lead sponsor

SWOG Cancer Research Network is the lead sponsor of 339 studies on the registry; 37 are open to participants now.

Of its 17 completed or terminated interventional studies of FDA-regulated products, 17 (100%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Participants must have a histologic diagnosis of well-differentiated pancreatic neuroendocrine tumor (pNET) that was resected between 14 and 120 days prior to registration. Participants must have a scan within 90 days prior to registration without evidence of disease. Acceptable scans are multiphase computed tomography (CT) abdomen, magnetic resonance imaging (MRI) with intravenous (IV) contrast of the abdomen, or positron emission tomography (PET)-CT DOTATATE imaging if the DOTATATE PET-CT included IV iodine contrast for the CT portion of the exam
  • Resection must have been an R0 or R1 per treating investigator's assessment and/or pathology report
  • Ki-67 testing, which is considered part of standard of care in the pathology report, must have been performed between 14 and 90 days prior to registration and the result must be >= 3% and =\< 55%. Treating investigators are encouraged to contact the S2104 Study Chairs and/or the study pathology chair with questions. If more than one Ki-67 is reported (e.g., primary tumor versus lymph node or metastatic site), the highest one should be considered for the study eligibility criteria
  • Participants with localized resected pNETS must have a Zaidi score of >= 3 derived by the following factors and points:

    • 1 point; symptomatic tumor defined as one of the following:

      • Gastrointestinal bleed
      • Jaundice
      • Gastrointestinal obstruction
      • Pain from primary tumor prior to surgical resection
      • Pancreatitis
    • 2 points; primary pancreas tumor size > 2 cm
    • 1 point; Ki-67 3% to 20%
    • 1 point; lymph node positivity = 1
    • 6 points; Ki-67 21% to 55%
  • Participants may have received resection/ablation of liver oligo-metastatic disease (up to 5 liver metastases) at the time of well-differentiated pNET resection
  • Participants must have recovered from effects of surgery as determined by the treating investigator
  • Participants must be >= 18 years old
  • Participants must have Zubrod performance status of 0-2
  • Participants must have a complete medical history and physical exam within 28 days prior to registration
  • Leukocytes >= 3 x 10\^3/uL (within 28 days prior to registration)
  • >= 1.5 x 10\^3/uL (within 28 days prior to registration)
  • >= 100 x 10\^3/uL (within 28 days prior to registration)
  • Total =\< institutional (ULN) unless history of Gilbert's disease. Participants with history of Gilbert's disease must have total bilirubin =\< 5 x institutional ULN (within 28 days prior to registration)
  • (AST) and alanine aminotransferase (ALT) =\< 3 x institutional ULN (within 28 days prior to registration)
  • Serum creatinine =\< 1.5 x institutional ULN (within 28 days prior to registration)
  • Calculated >= 50 ml/min (within 28 days prior to registration)
  • Participants must be able to swallow pills
  • Participants must be able to tolerate CT or magnetic resonance (MR) imaging including contrast agents as required for their treatment and the protocol
  • No other active or history of prior malignancy is allowed, except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated stage I or II cancer from which the participant is currently in complete remission, or any other cancer from which the participant has been disease free for two years
  • Participants must be informed of the nature of this study and must sign and give in accordance with institutional and federal guidelines

Exclusion criteria

Exclusion Criteria:

  • Participants must not have unresected or unablated disease
  • Participants must not have clinically apparent central nervous system metastases or carcinomatous meningitis
  • Participants must not have received prior therapy for treatment of pancreatic neuroendocrine tumor. Use of somatostatin analogs prior to surgery is permitted
  • Participants must not have received somatostatin analogs after surgery
  • Participants must not be planning to receive warfarin while on protocol treatment. Other anticoagulants are allowed
  • Participants must not have history of allergic reactions attributed to compounds of similar chemical or biologic composition to temozolomide or capecitabine
  • Participants must not have known absorption issues that would limit the ability to absorb study agents
  • Participants must not have had an arterial thromboembolic event, unstable angina, or myocardial infarction within 12 months prior to registration
  • Participants must not have active or uncontrolled infection
  • Participants must not have serious medical or psychiatric illness that could affect study participation in the judgement of the treating investigator
  • Participants must not be pregnant due to the possibility of harm to the fetus. Individuals who are of must have agreed to use an effective method with details provided as a part of the consent process. A person who has had menses at any time in the preceding 12 consecutive months or who has semen likely to contain sperm is considered to be of "reproductive potential." In addition to routine contraceptive methods, "effective contraception" also includes refraining from sexual activity that might result in pregnancy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) including hysterectomy, bilateral oophorectomy, bilateral tubal ligation/occlusion, and vasectomy with testing showing no sperm in the semen
Terms in these criteria, in plain language(13)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Metastases

Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.

Absolute neutrophil count (ANC)

The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.

It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

Creatinine clearance (CrCl)

How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Adjuvant and neoadjuvant

Neoadjuvant treatment is given before the main treatment (usually surgery), often to shrink a tumour. Adjuvant treatment is given after it, to lower the chance of the cancer coming back.

Reproductive potential

Able to have children. For women this usually means from the first period until menopause, unless permanently unable to through surgery; for men, unless permanently sterile. Read who the line is about — participants, women, men, or their partners.

Criteria about it usually ask for contraception during the study and for a time after it.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
141 participants (estimated)

Study arms

  • Experimental
    Arm I (capecitabine, temozolomide)

    Patients receive capecitabine PO BID on days 1-14 and temozolomide PO once QD on days 10-14. Treatment repeats every 28 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.

    Drug: Capecitabine · Drug: Temozolomide

  • No intervention
    Arm II (surveillance)

    Patients undergo surveillance with no active treatment.

Interventions

  • Given PO

    Also known as: Ro 09-1978/000, Xeloda

  • Given PO

    Also known as: CCRG-81045, Imidazo[5,1-d]-1,2,3,5-tetrazine-8-carboxamide, 3, 4-dihydro-3-methyl-4-oxo-, M & B 39831, M and B 39831, Methazolastone, RP-46161, SCH 52365, Temcad, Temodal, Temodar, Temomedac, TMZ

06

What researchers measure

Primary outcomes

  1. Recurrence-free survival (RFS)

    Distribution of RFS in each arm will be estimated using the method of Kaplan-Meier and compared using the stratified log rank test.

    Time frame: From date of randomization to progression/recurrence or death from any cause, assessed up to 5 years

Secondary outcomes

  1. Overall survival (OS)

    Distribution of OS in each arm will be estimated using the method of Kaplan-Meier and compared using the stratified log rank test.

    Time frame: From date of registration to date of death due to any cause, assessed up to 5 years

  2. Incidence of adverse events

    Evaluated using National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0.

    Time frame: Up to 30 days after completion of treatment

07

Study locations

381 of 448 sites recruiting

Showing the first 100 of 448 sites across 3 countries. Choose a country and city above to see the rest.

08

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Started May 2022 (actual). Primary completion is estimated for Mar 2027, 58 months after the start.

Of 17 phase 2 interventional studies under Adenoma, Islet Cell, half reached primary completion within 70 months of starting (the median), counting those still running; a quarter within 33 and three quarters within 72. This study's planned 58 months is below that.

How these figures are worked out, and which studies are left out of them.

Registered
Sep 2, 2021
First posted
Sep 10, 2021
StartActual
May 5, 2022
Primary completionEst.
Mar 31, 2027
CompletionEst.
Mar 31, 2027
Last update
Dec 15, 2025
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Dec 15, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
09

Registry details

Key details

Study ID
NCT05040360
Responsible party
Sponsor
First posted
Sep 10, 2021
Start date
May 5, 2022
Primary completion
Mar 31, 2027 (estimated)
Completion
Mar 31, 2027 (estimated)
Last update
Dec 15, 2025

Study contacts

Heloisa P Soares
principal investigator · SWOG Cancer Research Network

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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No contact was published for this record. The registry link below has the sponsor’s details.

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Studies of the drugs tested here: Capecitabine · Temozolomide

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