Background: Patients with advanced lung neuroendocrine neoplasms (NENs) have few treatment options. Capecitabine and temozolomide have recently showed significant activity in patients with pancreatic NETs, but data in lung NETs are limited. Methods: We retrospectively reviewed the records of patients treated at a large NET referral center to identify patients seen between 1/2008 and 9/2018 with metastatic lung NENs who received treatment with capecitabine and temozolomide (CAPTEM). Patients who were not seen at the center within the first month of treatment were excluded. Small cell lung cancer patients were also excluded. The primary endpoint was overall response rate per RECIST 1.1. Secondary endpoints included progression free survival, overall survival, and toxicity. Results: 20 patients were identified who received treatment with capecitabine/temozolomide. 14 (70%) were typical lung NETs, 5 (25%) atypical carcinoids, and 1 (5%) was defined as a large cell neuroendocrine carcinoma. 6 patients (30%) exhibited a best response of PR per RECIST 1.1 criteria, 11 (55%) SD, and 2 (10%) PD. 1 patient died 2 months after starting treatment. 11 eventually progressed (radiographically or clinically), only 6 of whom exhibited progression per RECIST 1.1 criteria. Median PFS was 11 months (95% CI, 6 – 16 months). Median OS was 68 months (95% CI, 35 – 101 months). Toxicity profile was mild with mainly grade 1, expected toxicities. 6 patients required dose reduction due to toxicity (2 for diarrhea and nausea, 1 for hand foot syndrome, 3 for thrombocytopenia). Conclusions: We identified a group of patients with metastatic lung NENs who received treatment with the CAPTEM regimen and exhibited a favorable response rate to treatment with a relatively tolerable toxicity profile. This regimen warrants further exploration in a prospective clinical trial.