Abstract
To determine clinical efficacy, safety and prognostic factors of pemetrexed plus platinum as first- line treatment in patients with advanced non-small cell lung cancer (NSCLC). Clinical characteristics, short-term efficacy, survival and adverse reactions of 47 advanced non-squamous NSCLC patients who had received pemetrexed plus platinum as first-line treatment in Shanghai Pulmonary Hospital from January 2009 to June 2011 were retrospectively analyzed. The Chi-squared test was applied to statistically analyze the overall response rate (ORR), disease control rate (DCR) and toxicity reactions in both groups, while survival data wereanalyzed by Kaplan-Meier and logrank methods, and the COX proportional hazards model was adopted for a series of multi-factor analyses. Only two patients were lost to follow-up. The ORR, DCR, medium progression-free survival time (PFS) and medium overall survival (OS) were 31.9%, 74.5%, 5 months and 15.2 months, while 1- and 2-year survival rates were 63.8% (30/47) and 19.2% (9/47), respectively. Single-factor analysis showed that tumor pathological patterns and efficacy were in association with medium PFS (P<0.05), whereas tumor pathological patterns, smoking history and efficacy were closely connected with medium OS (P<0.05). Multi-factor analyses demonstrated that pathological patterns and efficacy were independent factors influencing OS (P<0.05). The rate of toxicity reactions in degree III/IV was low, including hematologic toxicity marked by decline in white blood cell count and decrease in the platelet count (PLT), and non-hematologic toxicity manifested by gastrointestinal reactions, such as nausea and vomiting. Pemetrexed plus platinum as first-line treatment has excellent efficacy and slight adverse reactions with favorable drug-tolerance in patients with advanced non-squamous NSCLC.
Highlights
Lung cancer is one of the most common causes in cancer-associated deaths, in which non-small cell lung cancer (NSCLC) accounts for 85% and most patients are in middle and advanced stage when being diagnosed (Li et al, 2012; Liu et al, 2013)
Chi-squared test indicated that age, gender, Eastern Cooperative Oncology Group (ECOG) score, TMN stages and chemotherapeutic protocols had no relation with chemotherapeutic efficacy. 15 patients with adeno-carcinoma reached partial response (PR), whereas the short-term efficacy of patients with large cell carcinoma and squamous adeno-carcinoma did not, and there was no significant difference in disease control rate (DCR) (P=0.219); patients accompanied with malignant pleural effusion were better than the others (P=0.046), but DCR still had no significant difference (P=0.324); and smoking history was associated with efficacy, but no differences were found in overall response rate (ORR) and DCR (Table 1)
Single-factor analysis influencing progression-free survival time (PFS) and overall survival (OS) demonstrated that tumor pathological patterns and
Summary
Lung cancer is one of the most common causes in cancer-associated deaths, in which non-small cell lung cancer (NSCLC) accounts for 85% and most patients are in middle and advanced stage when being diagnosed (Li et al, 2012; Liu et al, 2013). The famous clinical studies of JMDB, JMEI and JMEN, etc, showed that pemetrexed played an important role in first secondline maintenance treatment of NSCLC in that it was a cytotoxic drug with high efficacy and low toxicity (Hanna et al, 2004; Scagliotti et al, 2008; Ciuleanu et al, 2009). In 2009, pemetrexed plus platinum were included in the first-line treatment of NSCLC by National Comprehensive Cancer Network (NCCN), and has been widely prescripted in China (Deng et al, 2013; Lu et al, 2013). This study retrospectively analyzed the efficacy, survival and toxicity reactions of pemetrexed plus platinum on 47 patients with advanced NSCLC, hoping to obtain the application data and study the characteristics of effective population, so as to further explore the prognostic factors
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