Journal of the Formosan Medical Association
Volume 109, Issue 5 , Pages 338-344, May 2010

Pemetrexed for Heavily Pretreated Patients With Advanced Non-small Cell Lung Cancer

  • Jih-Hsiang Lee

      Affiliations

    • Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
    • National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei, Taiwan
    • ,
  • Chong-Jen Yu

      Affiliations

    • Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
    • ,
  • Kuan-Yu Chen

      Affiliations

    • Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
    • ,
  • Jin-Yuan Shih

      Affiliations

    • Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
    • ,
  • Yu-Lin Lin

      Affiliations

    • Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
    • ,
  • Chih-Hsin Yang

      Affiliations

    • Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
    • National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei, Taiwan
    • Graduate Institute of Oncology, National Taiwan University, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Chih-Hsin Yang, Department of Oncology, National Taiwan University Hospital, 7 Zhongshan South Road, Taipei, Taiwan

Received 9 April 2009; received in revised form 19 July 2009; accepted 10 August 2009.

Article Outline

Background/Purpose

The efficacy and safety of chemotherapy as third- or higher-line therapy for advanced non-small cell lung cancer (NSCLC) are unclear. The purpose of this study was to evaluate the efficacy and safety of pemetrexed for heavily pretreated, advanced NSCLC.

Methods

We retrospectively reviewed advanced NSCLC patients who received pemetrexed and more than two prior chemotherapy regimens. The tumor responses were evaluated by the Response Evaluation Criteria of Solid Tumors. Progression-free survival and overall survival were calculated by the Kaplan-Meier method. Toxicity was evaluated according to the Common Terminology Criteria for Adverse Events version 3.0.

Results

A total of 95 patients (53 men and 42 women) were included. The median age was 63 years (range, 29-83). Seventy (73.7%) patients had adenocarcinoma. The median number of prior systemic therapies was three (range, 2-7). The median number of cycles of pemetrexed therapy was four (range, 1-11). Seven (7.4%) patients achieved a partial response, and 33 (34.7%) had stable disease. The median progression-free survival was 11 6 days, and the median overall survival was 382 days. A trend toward increased progression-free survival was observed for patients who had non-squamous compared with squamous NSCLC.

Conclusion

Pemetrexed has modest efficacy for heavily pretreated NSCLC patients.

Key Words:  drug therapy , non-small cell lung carcinoma , pemetrexed , retrospective studies

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Parkin DM , Bray F , Ferlay J , et al.   Global cancer statistics, 2002 . CA Cancer J Clin . 2005;55:74–108
  2. Ramalingam S , Sandler AB . Salvage therapy for advanced non-small cell lung cancer: factors influencing treatment selection . Oncologist . 2006;11:655–665
  3. Ettinger DS , Bepler G , Bueno R , et al.   Non-small cell lung cancer clinical practice guidelines in oncology . J Natl Compr Canc Netw . 2006;4:548–582
  4. Shepherd FA , Dancey J , Ramlau R , et al.   Prospective randomized trial of docetaxel versus best supportive care in patients with non-small-cell lung cancer previously treated with platinum-based chemotherapy . J Clin Oncol . 2000;18:2095–2103
  5. Fossella FV , DeVore R , Kerr RN , et al.   Randomized phase III trial of docetaxel versus vinorelbine or ifosfamide in patients with advanced non-small-cell lung cancer previously treated with platinum-containing chemotherapy regimens. The TAX 320 Non-Small Cell Lung Cancer Study Group . J Clin Oncol . 2000;18:2354–2362
  6. Hanna N , Shepherd FA , Fossella FV , et al.   Randomized phase III trial of pemetrexed versus docetaxel in patients with non-small-cell lung cancer previously treated with chemotherapy . J Clin Oncol . 2004;22:1589–1597
  7. Mok T , Wu Y , Thongprasert S , et al.   Gefitinib or carboplatinpaclitaxel in pulmonary adenocarcinoma . N Engl J Med . 2009;361:947–957
  8. Shepherd FA , Rodrigues Pereira J , Ciuleanu T , et al.   Erlotinib in previously treated non-small-cell lung cancer . N Engl J Med . 2005;353:123–132
  9. de Marinis F , Grossi F . Clinical evidence for second- and third-line treatment options in advanced non-small cell lung cancer . Oncologist . 2008;13(Suppl 1):14–20
  10. Shih C , Chen VJ , Gossett LS , et al.   LY231514, a pyrrolo-[2,3-d]pyrimidine-based antifolate that inhibits multiple folate-requiring enzymes . Cancer Res . 1997;57:1116–1123
  11. Scagliotti GV , Ceppi P , Capelletto E , et al.   Updated clinical information on multitargeted antifolates in lung cancer . Clin Lung Cancer . 2009;10(Suppl 1):S35–S40
  12. Belani CP , Brodowicz T , Ciuleanu T , et al.   Maintenance pemetrexed (Pem) plus best supportive care (BSC) versus placebo (Plac) plus BSC: A randomized phase III study in advanced non-small cell lung cancer (NSCLC) . J Clin Oncol . 2009;27:CRA8000; (Meeting Abstracts)
  13. Scagliotti GV , Parikh P , von Pawel J , et al.   Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer . J Clin Oncol . 2008;26:3543–3551
  14. Gronberg BH , Bremnes RM , Flotten O , et al.   Phase III study by the Norwegian lung cancer study group: pemetrexed plus carboplatin compared with gemcitabine plus carboplatin as first-line chemotherapy in advanced non-small-cell lung cancer . J Clin Oncol . 2009;27:3217–3224
  15. Thatcher N , Chang A , Parikh P , et al.   Gefitinib plus best supportive care in previously treated patients with refractory advanced non-small-cell lung cancer: results from a randomised, placebo-controlled, multicentre study (Iressa Survival Evaluation in Lung Cancer) . Lancet . 2005;366:1527–1537
  16. Ozdogan M , Samur M , Bozcuk H , et al.   Is the thrid-line chemotherapy feasible for non-small cell lung cancer? A retrospective study . Turk J Cancer . 2004;34:19–23
  17. Massarelli E , Andre F , Liu DD , et al.   A retrospective analysis of the outcome of patients who have received two prior chemotherapy regimens including platinum and docetaxel for recurrent non-small-cell lung cancer . Lung Cancer . 2003;39:55–61
  18. Weiss GJ , Langer C , Rosell R , et al.   Elderly patients benefit from second-line cytotoxic chemotherapy: a subset analysis of a randomized phase III trial of pemetrexed compared with docetaxel in patients with previously treated advanced non-small-cell lung cancer . J Clin Oncol . 2006;24:4405–4411
  19. Sun JM , Lee KW , Kim JH , et al.   Efficacy and toxicity of pemetrexed as a third-line treatment for non-small cell lung cancer . Jpn J Clin Oncol . 2009;39:27–32
  20. Cullen MH , Zatloukal P , Sorenson S , et al.   A randomized phase III trial comparing standard and high-dose pemetrexed as second-line treatment in patients with locally advanced or metastatic non-small-cell lung cancer . Ann Oncol . 2008;19:939–945
  21. Ohe Y , Ichinose Y , Nakagawa K , et al.   Efficacy and safety of two doses of pemetrexed supplemented with folic acid and vitamin B12 in previously treated patients with non-small cell lung cancer . Clin Cancer Res . 2008;14:4206–4212
  22. Pirker R , Pereira JR , Szczesna A , et al.   Cetuximab plus chemotherapy in patients with advanced non-small-cell lung cancer (FLEX): an open-label randomised phase III trial . Lancet . 2009;373:1525–1531
  23. Miles DW , Smith IE , Coleman RE , et al.   A phase II study of pemetrexed disodium (LY231514) in patients with locally recurrent or metastatic breast cancer . Eur J Cancer . 2001;37:1366–1371
  24. Nakagawa K , Kudoh S , Matsui K , et al.   A phase I study of pemetrexed (LY231514) supplemented with folate and vitamin B12 in Japanese patients with solid tumours . Br J Cancer . 2006;95:677–682
  25. Ma CX , Nair S , Thomas S , et al.   Randomized phase II trial of three schedules of pemetrexed and gemcitabine as front-line therapy for advanced non-small-cell lung cancer . J Clin Oncol . 2005;23:5929–5937

PII: S0929-6646(10)60061-7

doi:10.1016/S0929-6646(10)60061-7

Journal of the Formosan Medical Association
Volume 109, Issue 5 , Pages 338-344, May 2010

Article Tools