19 A Kent and Medway Cancer Network (KMCN) audit of first-line treatment with cisplatin/pemetrexed (CisPem) in non squamous non-small cell lung cancer (NSCLC)

Abstract

Introduction: NICE approved CisPem for first-line treatment of advanced large cell or adenocarcinoma NSCLC patients in September 2009. We reviewed outcomes for this regimen within KMCN, a large cancer network of 1.8 million population. Therapy was given at 7 sites within a nurse led model incorporating close clinical oversight. Methods: A retrospective analysis of patients receiving CisPem as first-line treatment for NSCLC (September 2009 August 2010) was undertaken. Results: 39 chemotherapy-naive patients with locally advanced or metastatic non-squamous NSCLC were identified; 37 were treated with CisPem. Baseline demographics are shown below: 59% male; median age 63 years; smoking status 27% current, 32% previous, 38% unknown, 2.7% never-smokers; stage at presentation III = 22%, IV = 70%; performance status PS = 0 8%, PS = 1 84%, PS = 2 5%. Five patients did not receive treatment due to rapid progression. A median of 4 cycles of chemotherapy was delivered: 67% completed 4 cycles, 5.4% received 6 cycles, 13% only completed 1 2 cycles. Of 109 cycles of chemotherapy, just 0.9% of cycles were delayed. Cisplatin dose was reduced or omitted in 7% and 5% of cycles respectively. Pemetrexed doses were reduced or omitted in 4% and 5% of cycles respectively. 25% of patients were admitted at some point during their chemotherapy. The reasons for admission were non-neutropenic sepsis (12%), thromboembolic phenomena (24%) and progressive disease (64%). There were no deaths within 30 days of CisPem administration. Partial responses were documented in 62.5% of cases. Stable disease was seen in 12.5% and progressive disease in 25%. As of August 2010, 12 patients had died (median overall survival of 6.5 months and median progression-free survival 6.0 months). Conclusions: First line CisPem delivered within a community/nurseled setting provides similar efficacy outcomes to published trial data. The high rate of hospital admission and thromboembolic complications warrants further investigation.