Abstract
This study was conducted to observe the efficacy and safety of pemetrexed based chemotherapy in treating patients with locally advanced or metastatic cancers as first-line, second-line or third-line therapy. From May 2011 to January 2015, we recruited 29 patients with advanced breast cancer, 19 patients with advanced ovary cancer, 17 patients with advanced esophageal cancer,5 patients with advanced gallbladder cancer,5 patients with advanced cervical cancer and 1 patient with advanced tongue cancer in Jiangsu Cancer Hospital and Research Institute.All of them were pathologically confirmed and treated with pemetrexed based chemotherapy. After two cycles of treatment,efficacy and safety can be evaluated. For pemetrexed based regimens,including 76 patients with 6 kinds of advanced cancer were considered eligible for inclusion. Complete remission represents CR, partial remission represents PR, stable disease represents SD, progressive disease represents PD. Among 29 patients with advanced breast cancer, 4 patients chose pemetrexed based regimens as second-line treatment,1 of them was PR,the other 3 got SD. The last 25 patients made use of this chemotherapy as third-line treatment, except one patient could not be assessed, 2 of them got PR,6 of them got SD,the remaining 16 of them finally were PD.19 patients with advanced ovary cancer,5 patients used this regimens as second-line treatment, 3 of them got PD,the remaining patients got SD, respectively. The last 14 patients made use of pemetrexed based regimens as third-line treatment,. RR (CR+PR) was 28.5%. Among 17 patients with advanced esophageal cancer, 2 patients made use of pemetrexed based regimens as first-line treatment,both of them got PR.4 of them used this chemotherapy as second-line regimen, except 2 patients could not be assessed,the remaining 2 was PD at last. The last 11 patients was third-line users, RR (CR+PR) was 18.2%. Among 5 patients with advanced gallbladder cancer, pemetrexed based regimens was used in 1 patient as first- line treatment and 1 patient as second-line treatment. The curative effect was SD and PD, respectively. 3 patients accepted pemetrexed based regimens as third-line treatment, 2 of them got PD as results and another was SD. Among 5 patients with advanced cervical cancer, just 1 patient adopted pemetrexed based regimens as first-line treatment, whose curative effect was PR.2 patients chose this chemotherapy regimens as second-line treatment. Both of them got PD as their consequence. The last 2 patients made use of the regimens as third-line treatment, the effect of them was PD and SD, respectively. The one who with advanced tongue cancer, pemetrexed based regimens was used as second-line treatment, and the consequence was PD. About 71.1% patients experienced bone marrow suppression. Among them, 5 patients reached 4 grade. Other toxicity of pemetrexed were neurotoxicity, fatigue, diarrhea, dysphagia and vomiting. No treatment related death occurred with pemetrexed-based treatment. Pemetrexed based chemotherapy has considerable effect in patients with advanced cancers such as breast cancer,esophageal cancer and ovary cancer. More randomly clinical trials are needed to verify the results.
Highlights
Pemetrexed is the first agent approved for the treatment of malignant pleural mesothelioma (MPM)
A total of 76 patients were enrolled in this study between May 2011 to January 2015. 29 patients with advanced breast cancer, 19 of them with advanced ovarian cancer, 17 of them with advanced esophageal cancer, 5 of them with advanced gallbladder cancer, 5 of them with advanced cervical cancer, and the last one with advanced tongue cancer
All of them experienced first, second-line chemotherapy or surgical treatment, but the results were failure or recurrence.In the midst of the 29 patients with advanced breast cancer, 4 of them made use of pemetrexed-based regimen as second-line treatment, 3 of them got SD as results, and the last one got PR.25 of them chose this regimen as third-line treatment, one of them was unable to assess.16 patients got PD, SD in 6 and the remaining 2 were PR
Summary
Pemetrexed is the first agent approved for the treatment of malignant pleural mesothelioma (MPM). In August 2004, pemetrexed was approved as a second-line, singleagent treatment of locally advanced or metastatic nonsmall cell lung cancer (NSCLC). The clinical development of pemetrexed in relation to other advanced cancers would be discussed. Pemetrexed (PMX) is a newly developed multi-targeted anti-folate with promising clinical activity in many solid tumors (Essam et al, 2015). Three enzymes thymidine nucleoside Acid synthetase (thymidylate synthetase, TS), dihydrofolate reductase glycinamide called formyltransferase DHFR and Amino acid RNA nucleoside acyltransferase (dihydrofolate reductase, ARFT), are involved in terminating cell cycle in S phase. (Giovannetti et al, 2004; Scagliotti et al, 2008).
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