Abstract

Combination of chemotherapy and epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) had been proved to be a potent anti-drug for the treatment of tumors. However, survival time was not extended for the patients with lung adenocarcinoma (AdC) compared with first-line chemotherapy. In the present study, we attempt to assess the optimal schedule of the combined administration of pemetrexed and icotinib/erlotinib in AdC cell lines. Human lung AdC cell lines with wild-type (A549), EGFR T790M (H1975) and activating EGFR mutation (HCC827) were applied in vitro to assess the differential efficacy of various sequential regimens on cell viability, cell apoptosis and cell cycle distribution. The results suggested that the antiproliferative effect of the sequence of pemetrexed followed by icotinib/erlotinib was more effective than that of icotinib/erlotinib followed by pemetrexed. Additionally, a reduction of G1 phase and increased S phase in sequence of pemetrexed followed by icotinib/erlotinib was also observed, promoting cell apoptosis. Thus, the sequential administration of pemetrexed followed by icotinib/erlotinib exerted a synergistic effect on HCC827 and H1975 cell lines compared with the reverse sequence. The sequential treatment of pemetrexed followed by icotinib/erlotinib has been demonstrated promising results. This treatment strategy warrants further confirmation in patients with advanced lung AdC.

Highlights

  • As a life-threatening malignancy, advanced-stage non-small-cell lung cancer (NSCLC) is responsible for 17% of the total new cancer cases and 23% of the total cancer deaths, and accounts for approximately 87% of lung cancer cases [1]

  • In the HCC827 and H1975 cell lines, the sequence of pemetrexed followed by icotinib/ erlotinib exhibited a synergistic antiproliferative effect (CI1 represented antagonistic effects in the sequence of icotinib/erlotinib followed by pemetrexed and the concomitant treatment (CI>1)

  • The results showed that the antiproliferative effect of the sequence of pemetrexed followed by icotinib or erlotinib was more prominent than that of icotinib/erlotinib followed by pemetrexed

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Summary

Introduction

As a life-threatening malignancy, advanced-stage non-small-cell lung cancer (NSCLC) is responsible for 17% of the total new cancer cases and 23% of the total cancer deaths, and accounts for approximately 87% of lung cancer cases [1]. There exists broad evidence base supporting the administration of platinum-based combination chemotherapy has been a first-line treatment for advanced NSCLC for years [3, 4]. Pemetrexed, a treatment option for patients with advanced non-squamous NSCLC, had no significant differences in efficacy and safety compared with other chemotherapy options in second line treatment. It should be reasonable to optimize its use, since pemetrexed is relatively less toxic and currently used as continuation maintenance therapy for longer period, and the high budgetary impact of its incorporation into health system is of concern. Optimum regimen of pemetrexed in the treatment of NSCLC should be investigated [6]

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