Prospective comparative study of pemetrexed and carboplatin versus paclitaxel and carboplatin as first-line chemotherapy in adenocarcinoma lung

Abstract

Background: The worldwide epidemiology of lung cancer is ever changing, and non-squamous non-small-cell lung cancer (NSCLC) in never-smoking women has been gradually increasing. In Indian population, adenocarcinoma lung was more common in never smoker persons. Approximately 70–80% of lung cancer cases are NSCLC. Most of NSCLC patients present with advanced disease or brain metastasis. The prognosis of patients with advanced NSCLC is generally considered poor, with a median survival of 9–11 months and a 2-year survival around 20–30%. There are no enough data in Eastern India regarding disease response, treatment-related toxicity, overall survival, and progression-free survival in advanced adenocarcinoma lung treated with chemotherapy and radiotherapy. Objectives: The objectives of this study were to compare disease response, toxicity, overall survival, and progression-free survival in advanced adenocarcinoma lung treated as first line with pemetrexed/carboplatin versus paclitaxel/carboplatin. Materials and Methods: A total of 123 patients were placed in Group A and another 117 in Group B (stage III disease). Group A patients were treated with pemetrexed 500 mg/m2 and carboplatin area under the concentration (AUC) 6 every 3 week. Group B patients were treated with carboplatin at dose AUC 6 and paclitaxel 200 mg/m2 administered 3 weekly. Dose of radiation was planned 60 Gy in 30# for 6 weeks in conventional fractionation schedule 3 weeks after completion of chemotherapy. Results: Hematological toxicities were Grade 3 anemia 27 (22%) in Group A and 29 (24.8%) Group B, Grade 3 neutropenia 34 (27.6%) in Group A and 33 (28.2%) in Group B, and Grade 4 neutropenia 5 (4%) in Group A and 4 (3.4%) in Group B. Grade 3 sensory neuropathy was seen in Group B 17 (14.5%). There was no Grade 3 or Grade 4 sensory neuropathy in Group A. Grade 3 fatigue was seen in Group B 19 (16.2%). Grade 3 diarrhea was seen 9 (7.3%) in Group A and 8 (6.8%) in Group B. Overall response rate was 63 (51.2%) in Group A and 43 (36.8%) in Group B. The complete response of disease was 19 (15.4%) in Group A and 6 (5.1%) in Group B. The partial response was 44 (34.6%) in Group A and 37 (31.6%) in Group B. Stable disease was 41 (33.3%) in Group A and 51 (43.6%) in Group B. The progressive disease was 19 (15.4%) in Group A and 23 (19.6%) in Group B. Median overall survival was 14.6 months in Group A and 14.4 months in Group B. Conclusion: In our study, pemetrexed/carboplatin provides better efficacy and tolerance, a reduced need for supportive therapies, and more convenient administration than paclitaxel/carboplatin for the first-line treatment of patients with advanced adenocarcinoma lung.