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Joel A, John G, Daniel S, Thomas V, Sebastian A, Ramireddy JK, Chandramohan A, John AO, Georgy JT, Chacko RT, Yadav B, Singh A. Platinum-Pemetrexed Chemotherapy for Recurrent Ovarian Cancer (ROC): A Single Center Experience. Cancer Invest 2021; 39:893-901. [PMID: 34486892 DOI: 10.1080/07357907.2021.1973021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this retrospective analysis of 36 patients with recurrent ovarian cancer (ROC) treated with platinum pemetrexed doublet ± bevacizumab, the median age was 54.5 years (47-60) and 33 (91.7%) had serous histology. The overall response rate [ORR = complete (CR)+partial (PR) response] was 83.3%. At a median follow-up of 16 months, the median PFS was 13.8 months (95% CI: 10.849-20.580) and median OS 30.6 months, (95% CI: 21.46 months-NR). The incidence of Grade 3/4 anemia, thrombocytopenia, neutropenia and non-hematological toxicity was 19.4%, 3.9%, 16.6%, and 8.3%. Platinum pemetrexed chemotherapy in ROC is safe and effective treatment option.
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Affiliation(s)
- Anjana Joel
- Department of Medical Oncology, CMC Vellore, Vellore, India
| | - George John
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Sherin Daniel
- Department of Pathology, CMC Vellore, Vellore, India
| | - Vinotha Thomas
- Department of Gynecologic Oncology, CMC Vellore, Vellore, India
| | - Ajit Sebastian
- Department of Gynecologic Oncology, CMC Vellore, Vellore, India
| | | | | | | | | | | | - Bijesh Yadav
- Department of Biostatistics, CMC Vellore, Vellore, India
| | - Ashish Singh
- Department of Medical Oncology, CMC Vellore, Vellore, India
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He K, Liu J, Gao Y, Hao Y, Yang X, Huang G. Preparation and Evaluation of Stearylamine-Bearing Pemetrexed Disodium-Loaded Cationic Liposomes In Vitro and In Vivo. AAPS PharmSciTech 2020; 21:193. [PMID: 32661922 DOI: 10.1208/s12249-019-1586-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/20/2019] [Indexed: 01/10/2023] Open
Abstract
Pemetrexed disodium (PMX) stands out in the treatment of non-small cell lung cancer (NSCLC), but with short half-life and toxic side effects. This study was to design cationic liposomes for targeting delivery PMX to the lungs. The PMX cationic liposome was prepared by thin-film hydration using stearylamine (SA) as the positive component of charge-regulating charge. Then, the PMX cationic liposome (SA-PMX-Lips) was characterized by particle size, morphology, entrapment efficiency (EE), and drug loading (DL). Finally, the drug release behavior in vitro, the pharmacokinetic study, and tissue distribution of SA-PMX-Lips were evaluated separately, with PMX solution (PMX-Sol) and PMX liposome (PMX-Lips) as the control. According to results, SA-PMX-Lips were spherical and the particle size was 219.7 ± 4.97 nm with a narrow polydispersity index (PDI) (0.231 ± 0.024) and a positive zeta potential 22.2 ± 0.52 mV. Its EE was 92.39 ± 1.94% and DL was 9.15 ± 0.07%. The results of in vitro and in vivo experiments showed that SA-PMX-Lips released slowly, prolonged retention time and increased the value of AUC. More notably, SA-PMX-Lips could improve the accumulation of drugs in the lungs and the relative uptake rate (Re) was 2.35 in the lungs, which indicated its lung targeting. In summary, SA-PMX-Lips showed the potential for the effective delivery of PMX and the treatment of NSCLC.
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3
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López-Plana A, Fernández-Nogueira P, Muñoz-Guardiola P, Solé-Sánchez S, Megías-Roda E, Pérez-Montoyo H, Jauregui P, Yeste-Velasco M, Gómez-Ferreria M, Erazo T, Ametller E, Recalde-Percaz L, Moragas-Garcia N, Noguera-Castells A, Mancino M, Morán T, Nadal E, Alfón J, Domènech C, Gascon P, Lizcano JM, Fuster G, Bragado P. The novel proautophagy anticancer drug ABTL0812 potentiates chemotherapy in adenocarcinoma and squamous nonsmall cell lung cancer. Int J Cancer 2020; 147:1163-1179. [PMID: 31943158 DOI: 10.1002/ijc.32865] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/18/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022]
Abstract
Around 40% of newly diagnosed lung cancer patients are Stage IV, where the improvement of survival and reduction of disease-related adverse events is the main goal for oncologists. In this scenario, we present preclinical evidence supporting the use of ABTL0812 in combination with chemotherapy for treating advanced and metastatic Nonsmall cell lung adenocarcinomas (NSCLC) and squamous carcinomas. ABTL0812 is a new chemical entity, currently in Phase 1b/2a clinical trial for advanced squamous NSCLC in combination with paclitaxel and carboplatin (P/C), after successfully completing the first-in-human trial where it showed an excellent safety profile and signs of efficacy. We show here that ABTL0812 inhibits Akt/mTOR axis by inducing the overexpression of TRIB3 and activating autophagy in lung squamous carcinoma cell lines. Furthermore, treatment with ABTL0812 also induces AMPK activation and ROS accumulation. Moreover, combination of ABTL0812 with chemotherapy markedly increases the therapeutic effect of chemotherapy without increasing toxicity. We further show that combination of ABTL0812 and chemotherapy induces nonapoptotic cell death mediated by TRIB3 activation and autophagy induction. We also present preliminary clinical data indicating that TRIB3 could serve as a potential novel pharmacodynamic biomarker to monitor ABTL0812 activity administered alone or in combination with chemotherapy in squamous NSCLC patients. The safety profile of ABTL0812 and its good synergy with chemotherapy potentiate the therapeutic potential of current lines of treatment based on chemotherapy regimens, arising as a promising option for improving these patients therapeutic expectancy.
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Affiliation(s)
- Anna López-Plana
- Molecular and Translational Oncology Group, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Biochemistry and Molecular Biomedicine Department, School of Biology, University of Barcelona, Barcelona, Spain.,Institut de Biomedicina de la Universitat de Barcelona (IBUB), University of Barcelona, Barcelona, Spain
| | - Patricia Fernández-Nogueira
- Molecular and Translational Oncology Group, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pau Muñoz-Guardiola
- Protein Kinases and Signal Transduction Laboratory, Institut de Neurociències and Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.,Ability Pharmaceuticals, SL, Cerdanyola Del Vallès, Barcelona, Spain
| | | | - Elisabet Megías-Roda
- Protein Kinases and Signal Transduction Laboratory, Institut de Neurociències and Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.,Ability Pharmaceuticals, SL, Cerdanyola Del Vallès, Barcelona, Spain
| | | | - Patricia Jauregui
- Molecular and Translational Oncology Group, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | | | - Tatiana Erazo
- Protein Kinases and Signal Transduction Laboratory, Institut de Neurociències and Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Elisabet Ametller
- Molecular and Translational Oncology Group, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Leire Recalde-Percaz
- Molecular and Translational Oncology Group, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Biochemistry and Molecular Biomedicine Department, School of Biology, University of Barcelona, Barcelona, Spain.,Institut de Biomedicina de la Universitat de Barcelona (IBUB), University of Barcelona, Barcelona, Spain
| | - Núria Moragas-Garcia
- Molecular and Translational Oncology Group, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Mario Mancino
- Molecular and Translational Oncology Group, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Biochemistry and Molecular Biomedicine Department, School of Biology, University of Barcelona, Barcelona, Spain.,Institut de Biomedicina de la Universitat de Barcelona (IBUB), University of Barcelona, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Teresa Morán
- Medical Oncology Department, Catalan Institute of Oncology - Badalona, Hospital Universitari Germans Trias i Pujol, Institut Germans Trias i Pujol, Badalona-Applied Research Group in Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ernest Nadal
- Department of Medical Oncology, Thoracic Oncology Multidisciplinary Unit, Catalan Institute of Oncology, Barcelona, Spain
| | - José Alfón
- Protein Kinases and Signal Transduction Laboratory, Institut de Neurociències and Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Carles Domènech
- Ability Pharmaceuticals, SL, Cerdanyola Del Vallès, Barcelona, Spain
| | - Pere Gascon
- Molecular and Translational Oncology Group, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Biochemistry and Molecular Biomedicine Department, School of Biology, University of Barcelona, Barcelona, Spain.,Institut de Biomedicina de la Universitat de Barcelona (IBUB), University of Barcelona, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain.,Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
| | - Jose M Lizcano
- Protein Kinases and Signal Transduction Laboratory, Institut de Neurociències and Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Gemma Fuster
- Molecular and Translational Oncology Group, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Biochemistry and Molecular Biomedicine Department, School of Biology, University of Barcelona, Barcelona, Spain.,Department of Biochemistry & Physiology, School of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain.,Department of Biosciences, Faculty of Sciences and Technology, University of Vic, Vic, Spain
| | - Paloma Bragado
- Molecular and Translational Oncology Group, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Complutense University of Madrid, Health Research Institute of the Hospital Clínico San Carlos, Madrid, Spain
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Accumulated cytotoxicity of CDK inhibitor dinaciclib with first-line chemotherapy drugs in salivary adenoid cystic carcinoma cells. Odontology 2019; 108:300-311. [PMID: 31529315 DOI: 10.1007/s10266-019-00451-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/15/2019] [Indexed: 01/31/2023]
Abstract
Adenoid cystic carcinoma (ACC) is one of the most common salivary gland malignant tumors. Its treatment failure is partly due to the limitations of chemotherapeutic agents and their adverse effects. The objective of this study was to determine the potential additive anti-cancer effect of a novel CDK inhibitor dinaciclib with first-line chemotherapy drugs in ACC. Protein expression of phosphorylated CDK2 (p-CDK2) in paraffin-embedded tissue specimens of ACC from 17 patients was investigated by immunohistochemistry (IHC). Cell Counting Kit (CCK-8), clone formation assay, and flow cytometry were used to test the proliferation and apoptosis of ACC-2 cells treated with dinaciclib with or without other first-line chemotherapy drugs. Protein expression was also determined by Western blot. Interestingly, we discovered that p-CDK2 protein was expressed in both cytoplasmic and nucleus in salivary ACC tissues, which was higher than that in normal salivary tissues, indicating that agents targeting CDK2 may be potential therapeutic strategies against this type of tumor. As expected, CDK inhibitor dinaciclib significantly induced ACC-2 cells apoptosis. Moreover, it sensitized cells to the chemotherapeutic agents such as cisplatin, pemetrexed, and etoposide (VP-16), and this effect by dinaciclib may induce cell cycle arrest via abrogating CDK2 activity. Therefore, combinational therapy of CDK inhibitor dinaciclib with first-line chemotherapy drugs may be a promising strategy in the treatment of salivary ACC.
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Rossi G, Alama A, Genova C, Rijavec E, Tagliamento M, Biello F, Coco S, Dal Bello MG, Boccardo S, Grossi F. The evolving role of pemetrexed disodium for the treatment of non-small cell lung cancer. Expert Opin Pharmacother 2018; 19:1969-1976. [PMID: 30354693 DOI: 10.1080/14656566.2018.1536746] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Non-small cell lung cancer (NSCLC) remains one of the big cancer killers, despite the introduction of a number of approved therapeutics in recent times. Pemetrexed is a multi-target folate inhibitor, which is currently available to patients affected by advanced non-squamous NSCLC in combination with a platinum derivate in first-line therapy and as a single agent in second-line therapy. Areas covered: This review covers presents the use pemetrexed in the management of NSCLC by exploring the data available from clinical trials and meta-analyses. Data from a phase III trial confirmed its role in the first-line setting in combination with immune checkpoint inhibitors (ICIs). Furthermore, data suggested a role for pemetrexed in local and advanced NSCLC. Expert opinion: To date, in spite of the introduction of novel anti-neoplastic agents, pemetrexed still represents a cornerstone in the management of non-squamous NSCLC. Furthermore, recently published data support its role in innovative combinations including together with chemotherapy and immunotherapy.
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Affiliation(s)
- Giovanni Rossi
- a Lung Cancer Unit , Ospedale Policlinico San Martino , Genoa , Italy
| | - Angela Alama
- a Lung Cancer Unit , Ospedale Policlinico San Martino , Genoa , Italy
| | - Carlo Genova
- b Medical Oncology , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Erika Rijavec
- a Lung Cancer Unit , Ospedale Policlinico San Martino , Genoa , Italy
| | - Marco Tagliamento
- a Lung Cancer Unit , Ospedale Policlinico San Martino , Genoa , Italy
| | - Federica Biello
- a Lung Cancer Unit , Ospedale Policlinico San Martino , Genoa , Italy
| | - Simona Coco
- a Lung Cancer Unit , Ospedale Policlinico San Martino , Genoa , Italy
| | | | - Simona Boccardo
- a Lung Cancer Unit , Ospedale Policlinico San Martino , Genoa , Italy
| | - Francesco Grossi
- b Medical Oncology , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
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6
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Stout MC, Campbell PM. RASpecting the oncogene: New pathways to therapeutic advances. Biochem Pharmacol 2018; 158:217-228. [PMID: 30352234 DOI: 10.1016/j.bcp.2018.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/19/2018] [Indexed: 12/13/2022]
Abstract
RAS is the most commonly mutated driver of tumorigenesis, seen in about 30% of all cancer cases. There is a subset of tumors termed RAS-driven cancers in which RAS mutation or overactivation is evident, including as much as 95% in pancreatic and 50% in colon cancer. RAS is a family of small membrane bound GTPases that act as a signaling node to control both normal and cancer biology. Since the discovery of RAS' overall prominence in many tumor types and specifically in RAS-dependent cancers, it has been an obvious therapeutic target for drug development. However, RAS has proved a very elusive target, and after a few prominent RAS targeted drugs failed in clinical trials after decades of research, RAS was termed "undruggable" and research in this field was greatly hampered. An increase in knowledge about basic RAS biology has led to a resurgence in the generation of novel therapeutics targeting RAS signaling utilizing various and distinct approaches. These new drugs target RAS activation directly, block downstream signaling effectors and inhibit proper post-translational processing and trafficking/recycling of RAS. This review will cover how these new drugs were developed and how they have fared in preclinical and early phase clinical trials.
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Affiliation(s)
- Matthew C Stout
- Department of Pharmacology and Physiology, College of Medicine, Drexel University, USA; Cancer Biology Program and The Marvin & Concetta Greenberg Pancreatic Cancer Institute, Fox Chase Cancer Center, USA
| | - Paul M Campbell
- Cancer Biology Program and The Marvin & Concetta Greenberg Pancreatic Cancer Institute, Fox Chase Cancer Center, USA.
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Hainsworth JD, Waterhouse DM, Shih KC, Boccia RV, Priego VM, McCleod MJ, Kudrik FJ, Mitchell RB, Burris HA, Greco FA, Spigel DR. Phase II trial of preoperative pemetrexed plus carboplatin in patients with stage IB-III nonsquamous non-small cell lung cancer (NSCLC). Lung Cancer 2018; 118:6-12. [DOI: 10.1016/j.lungcan.2018.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 12/13/2017] [Accepted: 01/16/2018] [Indexed: 11/26/2022]
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8
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Zhu Y, Xing P, Wang S, Ma D, Mu Y, Li X, Xu Z, Li J. Evaluation of calculating carboplatin dosage in carboplatin-pemetrexed therapy as the first-line therapy for Chinese patients with advanced lung adenocarcinoma. Thorac Cancer 2018; 9:400-407. [PMID: 29377581 PMCID: PMC5832477 DOI: 10.1111/1759-7714.12594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE This study aims to explore the application of actual carboplatin in carboplatin plus pemetrexed regimen as first-line treatment for advanced lung adenocarcinoma, and to determine the recommended dose of carboplatin for Chinese populations. METHODS From January 2014 to April 2016, 151 advanced lung adenocarcinoma patients who received carboplatin and pemetrexed (500 mg/m2 ) were included. The area under the curve (AUC) of carboplatin was back-calculated from actual dosages using the Calvert formula. According to the median of calculated AUC, patients were divided into AUC ≥4 and <4 groups. RESULTS The median of AUC was 4 (1.8-5.5). A total of 79 patients had an AUC ≥4 and 72 patients had an AUC <4. The mean relative dose intensities of pemetrexed were 100.4% for the AUC ≥4 group, and 101.4% for <4 group. Baseline characteristic variables were balanced between the two groups, except for Eastern Cooperative Oncology Group Performance score (P = 0.044). The overall response rate (ORR) and disease control rate (DCR) were 33.8% and 90.1%, respectively, 35.4% and 86.1% for the AUC ≥4 group, and 31.9% and 94.4% for the AUC <4 group. No significant difference was observed in ORR (P = 0.650) and DCR (P = 0.086) between the two groups. CONCLUSION Compared with an AUC of 5 or 6, the actual clinical application of AUC was generally insufficient for Chinese populations; fortunately, therapeutic efficacy remained equal. We found that AUC <4 was as adequate as AUC ≥4 in pemetrexed plus carboplatin regimen as first-line treatment for them.
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Affiliation(s)
- Yixiang Zhu
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Puyuan Xing
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Shouzheng Wang
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Di Ma
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yuxin Mu
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xue Li
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Ziyi Xu
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Junling Li
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Tian Y, Wang Z, Liu X, Duan J, Feng G, Yin Y, Gu J, Chen Z, Gao S, Bai H, Wan R, Jiang J, Liu J, Zhang C, Wang D, Han J, Zhang X, Cai L, He J, Wang J. Prediction of Chemotherapeutic Efficacy in Non-Small Cell Lung Cancer by Serum Metabolomic Profiling. Clin Cancer Res 2018; 24:2100-2109. [PMID: 29437793 DOI: 10.1158/1078-0432.ccr-17-2855] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/18/2017] [Accepted: 01/29/2018] [Indexed: 11/16/2022]
Abstract
Purpose: No validated biomarkers that could identify the subset of patients with lung adenocarcinoma who might benefit from chemotherapy have yet been well established. This study aimed to explore potential biomarker model predictive of efficacy and survival outcomes after first-line pemetrexed plus platinum doublet based on metabolomics profiling.Experimental Design: In total, 354 consecutive eligible patients were assigned to receive first-line chemotherapy of pemetrexed in combination with either cisplatin or carboplatin. Prospectively collected serum samples before initial treatment were utilized to perform metabolomics profiling analyses under the application of LC/MS-MS. Binary logistic regression analysis was carried out to establish discrimination models.Results: There were 251 cases randomly sorted into discovery set, the rest of 103 cases into validation set. Seven metabolites including hypotaurine, uridine, dodecanoylcarnitine, choline, dimethylglycine, niacinamide, and l-palmitoylcarnitine were identified associated with chemo response. On the basis of the seven-metabolite panel, a discriminant model according to logistic regression values g(z) was established with the receiver operating characteristic curve (AUC) of 0.912 (Discovery set) and 0.909 (Validation set) in differentiating progressive disease (PD) groups from disease control (DC) groups. The median progression-free survival (PFS) after chemotherapy in patients with g(z) ≤0.155 was significantly longer than that in those with g(z) > 0.155 (10.3 vs.4.5 months, P < 0.001).Conclusions: This study developed an effective and convenient discriminant model that can accurately predict the efficacy and survival outcomes of pemetrexed plus platinum doublet chemotherapy prior to treatment delivery. Clin Cancer Res; 24(9); 2100-9. ©2018 AACR.
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Affiliation(s)
- Yanhua Tian
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Zhijie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaohui Liu
- School of Life Sciences, Tsinghua University, Beijing, China
| | - Jianchun Duan
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Guoshuang Feng
- Center for Clinical Epidemiology & Evidence-based Medicine Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yuxin Yin
- Institute of Systems Biomedicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Jin Gu
- Department of GI Surgery III, Peking University Cancer Hospital, Beijing, China
| | - Zhaoli Chen
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hua Bai
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Rui Wan
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jun Jiang
- Department of Oncology, Affiliated Hospital of Qinghai University, Xining, P.R. China
| | - Jia Liu
- Institute of Systems Biomedicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Cong Zhang
- Institute of Systems Biomedicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Di Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Jiefei Han
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xue Zhang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Liangliang Cai
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Chen L, San Antonio B, Yan Y, Chen J, Goodloe RJ, John WJ. Safety profiles of non-small cell lung cancer patients treated with pemetrexed plus carboplatin: a real-world retrospective, observational, cohort study. Curr Med Res Opin 2017; 33:931-936. [PMID: 28276253 DOI: 10.1080/03007995.2017.1297700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Pemetrexed plus carboplatin (PCb) is a frequently used first-line treatment in advanced non-small cell lung cancer (NSCLC). This study examined the characteristics and safety profile of a NSCLC population treated with PCb area under the concentration-time curve 5 (PCb5) or 6 mg/mL•min (PCb6) under real-world conditions. RESEARCH DESIGN AND METHODS A retrospective, observational, cohort study was conducted, utilizing data from the IMS Oncology US clinic-based, longitudinal, patient-level electronic medical records (EMR), including patients with NSCLC on PCb5 or PCb6 regimens initiated concomitantly on or after the diagnosis of lung cancer during 2004-2014. Patient characteristics and incidence of adverse events (AEs) were described for each cohort. Propensity scores were calculated based on baseline demographic and clinical factors. Propensity score stratification was used to further adjust for cohort differences. RESULTS In total, 636 NSCLC patients receiving PCb5 (37% aged ≥70 years) and 184 patients receiving PCb6 (34% aged ≥70 years) who met the inclusion criteria were identified in the EMR. Patients with more comorbidities were more likely to have received PCb5. Overall incidence rates (IRs) per 100 person-years were similar for neutropenia in both cohorts, were numerically higher for anemia (IR = 43.6 vs 101.0) and thrombocytopenia (IR = 1.5 vs 17.9), and were numerically lower for nausea (IR = 14.4 vs 9.9) in the PCb6 vs PCb5 cohort. Within the PCb6 cohort, the IR per 100 person-years was higher for neutropenia for ≥70 year-old patients (IR = 41.1) compared to <70 year-old patients (IR = 14.5). After propensity score stratification, adjusted IRs showed similar patterns. LIMITATIONS Limitations included lack of power for AEs other than anemia, given the nature of EMR. CONCLUSIONS Results from this real-world analysis add to existing evidence from randomized clinical trials about PCb safety profiles in the overall NSCLC population and in elderly patients. These results may guide physicians when making treatment decisions.
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Affiliation(s)
- Lei Chen
- a Eli Lilly and Company , Indianapolis , IN , USA
| | | | - Yu Yan
- a Eli Lilly and Company , Indianapolis , IN , USA
| | - Jian Chen
- a Eli Lilly and Company , Indianapolis , IN , USA
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Okamoto I, Schuette WHW, Stinchcombe TE, Rodrigues-Pereira J, San Antonio B, Chen J, Liu J, John WJ, Zinner RG. Meta-analysis of pemetrexed plus carboplatin doublet safety profile in first-line non-squamous non-small cell lung cancer studies. Curr Med Res Opin 2017; 33:937-941. [PMID: 28277871 DOI: 10.1080/03007995.2017.1297701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This meta-analysis compared safety profiles (selected drug-related treatment-emergent adverse events [TEAEs]) of first-line pemetrexed plus carboplatin (PCb) area under the concentration-time curve 5 mg/min•mL (PCb5) or 6 mg/min•mL (PCb6), two widely used regimens in clinical practice for advanced non-squamous non-small cell lung cancer. METHODS All patients received pemetrexed 500 mg/m2 every 21 days with either of two carboplatin doses for up to 4-6 cycles. Safety profiles of PCb doses were compared using three statistical analysis methods: frequency table analysis (FTA), generalized linear mixed effect model (GLMM), and the propensity score method. Efficacy outcomes of PCb5 and PCb6 regimens were summarized. RESULTS A total of 486 patients mainly from the US, Europe, and East Asia were included in the analysis; 22% (n = 105) received PCb5 in one trial and 78% (n = 381) received PCb6 in four trials. The FTA comparison demonstrated that PCb5 vs PCb6 was associated with a statistically significantly lower incidence of TEAEs, including all-grade thrombocytopenia, anemia, fatigue, and vomiting, and grade 3/4 thrombocytopenia. In the GLMM analysis, PCb5 patients were numerically less likely to experience all-grade and grade 3/4 neutropenia, anemia, and thrombocytopenia. The propensity score regression analysis showed PCb5 group patients were significantly less likely than PCb6 group patients to experience all-grade hematologic TEAEs and grade 3/4 thrombocytopenia and anemia. After applying propensity score 1:1 matching, FTA analysis showed that the PCb5 group had significantly less all-grade and grade 3/4 hematologic toxicities. Overall efficacy outcomes, including overall survival, progression-free survival, and response rate, were similar between the two carboplatin doses. CONCLUSIONS Acknowledging the limitations of this meta-analysis of five trials, heterogeneous in patient's characteristics and trial designs, the results show that the PCb5 regimen was generally associated with a better safety profile than PCb6 across three statistical approaches, with no apparent impact on survival outcomes.
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Affiliation(s)
- Isamu Okamoto
- a Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | | | | | | | | | - Jian Chen
- f Eli Lilly and Company , Indianapolis , IN , USA
| | - Jingyi Liu
- f Eli Lilly and Company , Indianapolis , IN , USA
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Tomasini P, Barlesi F, Mascaux C, Greillier L. Pemetrexed for advanced stage nonsquamous non-small cell lung cancer: latest evidence about its extended use and outcomes. Ther Adv Med Oncol 2016; 8:198-208. [PMID: 27239238 DOI: 10.1177/1758834016644155] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is still the leading cause of cancer-related death, and the treatment of advanced NSCLC relies on systemic treatments. During the last decade, pemetrexed, an antifolate agent, gradually became a key component of the treatment for patients with advanced nonsquamous NSCLC. It has indeed been shown to be efficient for first-line, maintenance and second- or third-line treatment in this subgroup of NSCLC. Moreover, it is usually well tolerated, with few grade 3 and 4 toxicities. Several studies have tried to identify predictive biomarkers of pemetrexed efficacy. Due to pemetrexed's mechanism of action, thymidilate synthase expression predictive value was investigated but could not be demonstrated. Currently, more than 400 trials of pemetrexed for the treatment of nonsquamous NSCLC are ongoing.
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Affiliation(s)
- Pascale Tomasini
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Multidisciplinary Oncology & Therapeutic Innovations, Marseille, France
| | - Fabrice Barlesi
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Multidisciplinary Oncology & Therapeutic Innovations, Marseille, France
| | - Celine Mascaux
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Multidisciplinary Oncology & Therapeutic Innovations, Marseille, France
| | - Laurent Greillier
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Multidisciplinary Oncology & Therapeutic Innovations, Marseille, France
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Woo HI, Kim JA, Jung HA, Kim KK, Lee JY, Sun JM, Ahn JS, Park K, Lee SY, Ahn MJ. Correlation of genetic polymorphisms with clinical outcomes in pemetrexed-treated advanced lung adenocarcinoma patients. Pharmacogenomics 2016; 16:383-91. [PMID: 25823786 DOI: 10.2217/pgs.15.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Pemetrexed is a commonly used chemotherapeutic agent for lung adenocarcinoma patients. We investigated the impact of the genetic polymorphisms on the therapeutic efficacy of pemetrexed in lung adenocarcinoma patients. MATERIALS & METHODS We performed genotying of 51 polymorphisms of 13 genes in 243 lung adenocarcinoma patients treated with pemetrexed as a single agent for second or more line of therapy. RESULTS Total 12 polymorphisms in six genes were showed statistical significances in univariate analysis. After a false-discovery rate correction, the associations between GGH rs16930092 (p = 0.034) and rs10464903 (p = 0.034), and progression-free survival (PFS) were still conserved. Two polymorphisms in ATIC and GGH genes were associated with therapeutic efficacy in multivariate analysis: ATIC rs12995526 for tumor response (p = 0.014) and for overall survival (p = 0.006), and GGH rs16930092 (p = 0.009) for PFS. CONCLUSION This study shows that polymorphisms on genes related to the metabolic pathway of pemetrexed, especially, ATIC and GGH genes, would have a therapeutic implication in pemetrexed-treated patients with lung adenocarcinoma. Original submitted 10 May 2013; Revision submitted 27 June 2014.
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Affiliation(s)
- Hye In Woo
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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PRONOUNCE: randomized, open-label, phase III study of first-line pemetrexed + carboplatin followed by maintenance pemetrexed versus paclitaxel + carboplatin + bevacizumab followed by maintenance bevacizumab in patients ith advanced nonsquamous non-small-cell lung cancer. J Thorac Oncol 2015; 10:134-42. [PMID: 25371077 PMCID: PMC4276572 DOI: 10.1097/jto.0000000000000366] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION PRONOUNCE compared the efficacy and safety of pemetrexed+carboplatin followed by pemetrexed (Pem+Cb) with paclitaxel+carboplatin+bevacizumab followed by bevacizumab (Pac+Cb+Bev) in patients with advanced nonsquamous non-small-cell lung cancer (NSCLC). METHODS Patients ≥18 years of age with stage IV nonsquamous NSCLC (American Joint Committee on Cancer v7.0), and Eastern Cooperative Oncology Group performance status 0/1 were randomized (1:1) to four cycles of induction Pem+Cb (pemetrexed, 500 mg/m, carboplatin, area under the curve = 6) followed by Pem maintenance or Pac+Cb+Bev (paclitaxel, 200 mg/m, carboplatin, area under the curve = 6, and bevacizumab, 15 mg/kg) followed by Bev maintenance in the absence of progressive disease or discontinuation. The primary objective was progression-free survival (PFS) without grade 4 toxicity (G4PFS). Secondary end points were PFS, overall survival (OS), overall response rate (ORR), disease control rate (DCR), and safety. Resource utilization was also assessed. RESULTS Baseline characteristics of the patients randomized to Pem+Cb (N = 182) and Pac+Cb+Bev (N = 179) were well balanced between the arms. Median (months) G4PFS was 3.91 for Pem+Cb and 2.86 for Pac+Cb+Bev (hazard ratio = 0.85, 90% confidence interval, 0.7-1.04; p = 0.176); PFS, OS, ORR, or DCR did not differ significantly between the arms. Significantly more drug-related grade 3/4 anemia (18.7% versus 5.4%) and thrombocytopenia (24.0% versus 9.6%) were reported for Pem+Cb. Significantly more grade 3/4 neutropenia (48.8% versus 24.6%), grade 1/2 alopecia (28.3% versus 8.2%), and grade 1/2 sensory neuropathy were reported for Pac+Cb+Bev. Number of hospitalizations and overall length of stay did not differ significantly between the arms. CONCLUSIONS Pem+Cb did not produce significantly better G4PFS compared with Pac+Cb+Bev. Pem+Cb was not superior in PFS, OS, ORR, or DCR compared with Pac+Cb+Bev. Both regimens were well tolerated, although, toxicity profiles differed.
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NCCTG N0821 (Alliance): a phase II first-line study of pemetrexed, carboplatin, and bevacizumab in elderly patients with advanced nonsquamous non-small-cell lung cancer with good performance status. J Thorac Oncol 2015; 9:1146-53. [PMID: 25157767 DOI: 10.1097/jto.0000000000000217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND We hypothesized that the combination of bevacizumab, carboplatin, and pemetrexed will be an effective first-line regimen in fit, elderly patients with nonsquamous non-small-cell lung cancer. METHODS Treatment-naïve, stage IIIB/IV nonsquamous non-small-cell lung cancer patients more than 70 years old with good performance status (Eastern Cooperative Oncology Group performance status 0-1) and adequate organ function were eligible. Carboplatin area under the curve 6, pemetrexed 500 mg/m, and bevacizumab 15 mg/kg were administered on day 1 of each 21-day cycle (up to six cycles) followed by maintenance pemetrexed and bevacizumab. The primary end point of 6-month progression-free survival rate of at least 70% was assessed using a one-stage binomial design. Quality of life (QOL) questionnaires were administered. Polymorphisms in genes encoding relevant proteins (drug targets, transport, and metabolism proteins) were correlated with treatment outcome. RESULTS Fifty-seven eligible patients were enrolled. Median age was 74.5 years. Median treatment cycles received was 6. The most common grade 3 or higher non-hematologic adverse events were fatigue (26%) and hypertension (11%); 16% had grade 4 neutropenia and 6.5% had grade 4 thrombocytopenia. Three patients experienced grade 3/4 hemorrhagic events (one pulmonary, two gastrointestinal). Primary end point of PFS6 was 60% (95% confidence interval [CI]: 45.9-73%). Median PFS was 7.0 months (95% CI: 5.9-10.1), median overall survival was 13.7 months (95% CI: 9.4-16.8). Polymorphic KDR and VEGFA variants correlated with survival and toxicity, respectively. There was no significant change in overall QOL scores over time. CONCLUSION This regimen is feasible and did not decrease the QOL in this study population. However, it did not meet the primary efficacy end point.
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Sakata S, Sasaki J, Saeki S, Hamada A, Kishi H, Nakamura K, Tanaka H, Notsute D, Sato R, Saruwatari K, Iriki T, Akaike K, Fujii S, Hirosako S, Kohrogi H. Dose escalation and pharmacokinetic study of carboplatin plus pemetrexed for elderly patients with advanced nonsquamous non-small-cell lung cancer: Kumamoto thoracic oncology study group trial 1002. Oncology 2014; 88:201-7. [PMID: 25502447 DOI: 10.1159/000369255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/18/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study was designed to determine the recommended dose of carboplatin and pemetrexed for elderly (≥70-year-old) chemotherapy-naïve patients with advanced nonsquamous non-small-cell lung cancer (NSCLC) and to investigate the pharmacokinetics of pemetrexed. METHODS The patients were treated with 4-6 cycles of carboplatin plus a fixed dose of pemetrexed (500 mg/m(2)) every 3 weeks; the dose of carboplatin was escalated [from area under the curve (AUC) 4 to AUC 6]. To examine the pharmacokinetics of pemetrexed, blood samples were collected before and after pemetrexed infusion, and the blood levels of pemetrexed were measured by liquid chromatography-mass spectrometry. RESULTS Grade 3 infection as a dose-limiting toxicity was observed at a carboplatin dose of AUC 6. We therefore determined a carboplatin dose of AUC 5 and a pemetrexed dose of 500 mg/m(2) as the recommended doses from this study. The pharmacokinetic study showed a significant inverse correlation between the AUC of pemetrexed and the creatinine clearance. CONCLUSIONS For elderly chemotherapy-naïve patients with advanced nonsquamous NSCLC, the combination of carboplatin AUC 5 plus pemetrexed 500 mg/m(2) is recommended as a promising regimen; however, a reduction of the pemetrexed dose may be required for patients with renal dysfunction because of the high risk of hematotoxicities.
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Affiliation(s)
- Shinya Sakata
- Department of Respiratory Medicine, Kumamoto University Hospital, Kumamoto, Japan
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Jiang X, Yang B, Lu J, Zhan Z, Li K, Ren X. Pemetrexed-based chemotherapy in advanced lung adenocarcinoma patients with different EGFR genotypes. Tumour Biol 2014; 36:861-9. [DOI: 10.1007/s13277-014-2692-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022] Open
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Phase II trial of carboplatin and pemetrexed as first-line chemotherapy for non-squamous non-small cell lung cancer, and correlation between the efficacy/toxicity and genetic polymorphisms associated with pemetrexed metabolism: Hokkaido Lung Cancer Clinical Study Group Trial (HOT) 0902. Cancer Chemother Pharmacol 2014; 74:1149-57. [DOI: 10.1007/s00280-014-2589-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/08/2014] [Indexed: 01/27/2023]
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Li X, Wei S, Chen J. Critical appraisal of pemetrexed in the treatment of NSCLC and metastatic pulmonary nodules. Onco Targets Ther 2014; 7:937-45. [PMID: 24944517 PMCID: PMC4057332 DOI: 10.2147/ott.s45148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Pemetrexed, a new multitarget antifolate antineoplastic agent, has significantly improved the overall survival in nonsquamous non-small-cell lung cancer patients. Presently, pemetrexed is recommended for first line treatment in combination with platinum derivatives, for second line treatment as a single agent and, more recently, as maintenance treatment after first line chemotherapy. In this article we critically appraise the status of pemetrexed including pharmacodynamics, pharmacokinetics, toxicity, and the cost effectiveness of pemetrexed, as well as the predictive biomarkers for pemetrexed based chemotherapy.
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Affiliation(s)
- Xin Li
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Heping District, Tianjin, People's Republic of China
| | - Sen Wei
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Heping District, Tianjin, People's Republic of China
| | - Jun Chen
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Heping District, Tianjin, People's Republic of China
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Tomasini P, Greillier L, Khobta N, Barlesi F. The place of pemetrexed in the management of non-small-cell lung cancer patients. Expert Rev Anticancer Ther 2014; 13:257-66. [PMID: 23477511 DOI: 10.1586/era.12.171] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Non-small cell lung cancer (NSCLC) remains the leading cause of cancer death worldwide. Chemotherapy is included in the management of the majority of NSCLC patients either in addition to a local treatment (surgery/radiotherapy) or alone. In this setting, pemetrexed has become one of the most important partners of current chemotherapy regimens for nonsquamous NSCLC patients. Indeed, pemetrexed demonstrated a comparable efficacy to other previously available drugs in NSCLC, with however a better safety profile and an easier schedule of administration. In addition, pemetrexed demonstrated a greater efficacy in nonsquamous NSCLC that lead to an exploration of the underlying potential biological background. It is now suggested that the tumor thymidylate synthase level may act as a predictor of pemetrexed efficacy, therefore potentially providing clinicians in the future with a predictor of efficacy, which it is usually lacking with standard chemotherapies.
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Affiliation(s)
- Pascale Tomasini
- Aix-Marseille Université - Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology & Therapeutic Innovations Department, Chemin des Bourrely, 13915 Marseille Cedex 20, France
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Manegold C, Schmid-Bindert G, Pilz LR. Pemetrexed for the treatment of non-small-cell lung cancer. Expert Rev Anticancer Ther 2014; 9:1195-209. [DOI: 10.1586/era.09.97] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Okamoto I, Aoe K, Kato T, Hosomi Y, Yokoyama A, Imamura F, Kiura K, Hirashima T, Nishio M, Nogami N, Okamoto H, Saka H, Yamamoto N, Yoshizuka N, Sekiguchi R, Kiyosawa K, Nakagawa K, Tamura T. Pemetrexed and carboplatin followed by pemetrexed maintenance therapy in chemo-naïve patients with advanced nonsquamous non-small-cell lung cancer. Invest New Drugs 2013; 31:1275-82. [DOI: 10.1007/s10637-013-9941-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 02/19/2013] [Indexed: 11/25/2022]
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Sunitinib combined with pemetrexed and carboplatin in patients with advanced solid malignancies--results of a phase I dose-escalation study. Invest New Drugs 2013; 31:1487-98. [PMID: 23963796 PMCID: PMC3825543 DOI: 10.1007/s10637-013-0010-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 08/02/2013] [Indexed: 01/14/2023]
Abstract
Objectives The maximum tolerated dose (MTD) and overall safety of sunitinib plus pemetrexed and carboplatin was determined in patients with advanced solid malignancies. Methods In this phase I dose-escalation study, patients received oral sunitinib on a continuous daily dosing (CDD) schedule (37.5 mg/day) or Schedule 2/1 (2 weeks on treatment, 1 week off treatment; 37.5 or 50 mg/day). Pemetrexed (400–500 mg/m2 IV) and carboplatin (AUC = 5 mg·min/ml IV) were administered q3w. At the MTD for the chosen schedule, a cohort of patients with non-small cell lung cancer (NSCLC) or mesothelioma was further evaluated. Results Twenty-one patients were enrolled on Schedule 2/1 (expansion cohort included) and 3 patients on the CDD schedule. The MTD on Schedule 2/1 was sunitinib 37.5 mg/day with pemetrexed 500 mg/m2 and carboplatin AUC = 5 mg·min/ml; MTD on the CDD schedule was not established. Dose-limiting toxicities included grade 3/4 neutropenia, grade 3 thrombocytopenia, and grade 3 hand–foot syndrome. The most common grade 3/4 drug-related non-hematologic adverse events at Schedule 2/1 MTD were fatigue/asthenia and diarrhea (both n = 4). Grade 3/4 hematologic abnormalities included neutropenia (83 %) and leukopenia (83 %). Pharmacokinetic data revealed no clinically significant drug–drug interactions. Best response at the Schedule 2/1 MTD was stable disease ≥8 weeks in 3/5 evaluable patients (60 %). Conclusions With this combination, in patients with advanced solid malignancies, sunitinib MTD on Schedule 2/1 was 37.5 mg/day. Sunitinib plus pemetrexed and carboplatin were tolerable at the MTD, although sunitinib dose delays and reductions were often required due to myelosuppression.
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Genova C, Rijavec E, Truini A, Coco S, Sini C, Barletta G, Dal Bello MG, Alama A, Savarino G, Pronzato P, Boccardo F, Grossi F. Pemetrexed for the treatment of non-small cell lung cancer. Expert Opin Pharmacother 2013; 14:1545-58. [PMID: 23683110 DOI: 10.1517/14656566.2013.802774] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Non-small cell lung cancer (NSCLC) is a major cause of cancer-related death worldwide. Although advanced NSCLC is still incurable, various anti-neoplastic agents have become available for the treatment of this disease. Pemetrexed , a multi-target folate antagonist, has improved the survival of non-squamous NSCLC patients. Currently, pemetrexed is approved for first-line treatment in combination with a platinum derivate, for second-line treatment as a single agent and, more recently, as maintenance treatment after first-line chemotherapy. AREAS COVERED The authors analyzed the state of the art of pemetrexed through a review of the literature. Clinical trials and meta-analyses involving pemetrexed in NSCLC were evaluated. Pemetrexed improved survival of non-squamous NSCLC in first-line, maintenance, and second-line treatments; this benefit is limited to non-squamous histology. Because pemetrexed has become part of the standard of care, current clinical trials are designed to compare it to other investigational combinations. Limited data on resectable disease are available, and additional clinical trials are being conducted. EXPERT OPINION Pemetrexed has shown effectiveness and a favorable toxicity profile. Histology-driven indications and the relationship of pemetrexed with thymidylate synthase expression suggest that a more precise definition of predictive biomarkers could be further investigated.
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Affiliation(s)
- Carlo Genova
- IRCCS AOU San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Lung Cancer Unit, Genova, Italy.
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Xu B, Liu P, Yin Y, Liu P, Shu Y. Pemetrexed as the first-line therapy for Chinese patients with advanced non-squamous non-small-cell lung cancer. Biomed Pharmacother 2013; 67:763-9. [PMID: 23790249 DOI: 10.1016/j.biopha.2013.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 04/22/2013] [Indexed: 11/19/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) represents the most common cause of cancer mortality worldwide and counts for the greatest number of deaths from lung cancer in both men and women over age 60. Pemetrexed is a multi-targeted anti-metabolite and has shown comparable activity for Caucasian patients with advanced NSCLC. In this single-center retrospective study, we analyzed the outcome in 75 Chinese non-squamous NSCLC patients treated with pemetrexed as first-line therapy and assessed its efficacy and tolerability. The overall response rate was 9.3% (7/75) with 7 partial response s and no complete response. There were 44 (58.7%) stable diseases and 24 progressive diseases (32.0%). The median progression-free survival (PFS) was 6.79 months (95% CI 5.69-7.90 months), and the median overall survival (OS) was 11.67 months (95% CI 9.98-13.36 months). Good performance status and negative smoke history predicted better PFS and OS. Most side effects were generally mild and well tolerated. Taken together, pemetrexed was safe and effective in Chinese patients with non-squamous NSCLC. Pemetrexed alone or in combination with other efficacious drugs may serve as first-line therapy for this disease.
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Affiliation(s)
- Bei Xu
- Department of Medical Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
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Gervais R, Robinet G, Clément-Duchêne C, Denis F, Kouri CE, Martin P, Chouaki N, Bourayou N, Morère JF. Pemetrexed and carboplatin, an active option in first-line treatment of elderly patients with advanced non-small cell lung cancer (NSCLC): A phase II trial. Lung Cancer 2013; 80:185-90. [DOI: 10.1016/j.lungcan.2013.01.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 01/03/2013] [Accepted: 01/04/2013] [Indexed: 01/05/2023]
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Schuette WHW, Gröschel A, Sebastian M, Andreas S, Müller T, Schneller F, Guetz S, Eschbach C, Bohnet S, Leschinger MI, Reck M. A randomized phase II study of pemetrexed in combination with cisplatin or carboplatin as first-line therapy for patients with locally advanced or metastatic non-small-cell lung cancer. Clin Lung Cancer 2013; 14:215-23. [PMID: 23332288 DOI: 10.1016/j.cllc.2012.10.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 09/28/2012] [Accepted: 10/08/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pemetrexed plus cisplatin was approved for first-line treatment of non-small-cell lung cancer (NSCLC) in patients with nonsquamous histology after initiation of this study. This phase II study evaluated pemetrexed plus cisplatin and pemetrexed plus carboplatin as first-line treatments for stage IIIB/IV NSCLC. PATIENTS AND METHODS The patients were randomized (1:1) to 2 parallel arms: pemetrexed (500 mg/m(2)) plus cisplatin (75 mg/m(2)) or pemetrexed (500 mg/m(2)) plus carboplatin (area under the curve 6) day 1 every 3 weeks (maximum, 6 cycles). Progression-free survival (PFS) was the primary objective; secondary objectives included overall survival (OS), 1-year survival, and safety. RESULTS Sixty-five patients were randomized to each treatment arm. The patients treated with pemetrexed plus cisplatin had a median age of 64 years and were predominantly men (42 [64.6%]) with nonsquamous histology (53 [81.5%]), stage IV (61 [92.4%]) disease, and a performance status of 0 (40 [61.5%]). Median PFS was 6.0 months, 6-month PFS rate was 50.5%, median OS was 11.7 months, and 1-year survival rate was 47.5%. Drug-related grade 3/4 toxicities included neutropenia (11 [16.9%]), anemia (5 [7.7%]), thrombocytopenia (2 [3.1%]), and nausea (3 [4.6%]). Patients treated with pemetrexed plus carboplatin had a median age of 63 years, were predominantly men (46 [70.8%]) with nonsquamous histology (52 [80.0%]), stage IV (58 [86.6%]) disease, and a performance status of 0 (45 [69.2%]). The median PFS was 4.7 months, the 6-month PFS rate was 34.9%, median OS was 8.9 months, and 1-year survival rate was 39.2%. Drug-related grade 3/4 toxicities included neutropenia (17 [26.2%]), thrombocytopenia (11 [16.9%]), anemia (7 [10.8%]), and nausea (5 [7.7%]). CONCLUSIONS Both the pemetrexed plus cisplatin and pemetrexed plus carboplatin arms met their primary endpoints and demonstrated efficacy and tolerability as first-line therapy in patients with advanced NSCLC. http://ClinicalTrials.gov: NCT00402051.
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Affiliation(s)
- Wolfgang H W Schuette
- Department of Internal Medicine II, Hospital Martha-Maria, Halle-Dölau, Halle, Germany.
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ZHANG XINJI, LU JIAN, XU JINFANG, LI HUI, WANG JINGYI, QIN YINGYI, MA PILIN, WEI LIXIN, HE JIA. Pemetrexed plus platinum or gemcitabine plus platinum for advanced non-small cell lung cancer: final survival analysis from a multicentre randomized phase II trial in the East Asia region and a meta-analysis. Respirology 2012; 18:131-9. [DOI: 10.1111/j.1440-1843.2012.02248.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Ardizzoni A, Tiseo M, Boni L, Vincent AD, Passalacqua R, Buti S, Amoroso D, Camerini A, Labianca R, Genestreti G, Boni C, Ciuffreda L, Di Costanzo F, de Marinis F, Crinò L, Santo A, Pazzola A, Barbieri F, Zilembo N, Colantonio I, Tibaldi C, Mattioli R, Cafferata MA, Camisa R, Smit EF. Pemetrexed Versus Pemetrexed and Carboplatin As Second-Line Chemotherapy in Advanced Non–Small-Cell Lung Cancer: Results of the GOIRC 02-2006 Randomized Phase II Study and Pooled Analysis With the NVALT7 Trial. J Clin Oncol 2012; 30:4501-7. [DOI: 10.1200/jco.2012.43.6758] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose To compare efficacy of pemetrexed versus pemetrexed plus carboplatin in pretreated patients with advanced non–small-cell lung cancer (NSCLC). Patients and Methods Patients with advanced NSCLC, in progression during or after first-line platinum-based chemotherapy, were randomly assigned to receive pemetrexed (arm A) or pemetrexed plus carboplatin (arm B). Primary end point was progression-free survival (PFS). A preplanned pooled analysis of the results of this study with those of the NVALT7 study was carried out to assess the impact of carboplatin added to pemetrexed in terms of overall survival (OS). Results From July 2007 to October 2009, 239 patients (arm A, n = 120; arm B, n = 119) were enrolled. Median PFS was 3.6 months for arm A versus 3.5 months for arm B (hazard ratio [HR], 1.05; 95% CI, 0.81 to 1.36; P = .706). No statistically significant differences in response rate, OS, or toxicity were observed. A total of 479 patients were included in the pooled analysis. OS was not improved by the addition of carboplatin to pemetrexed (HR, 90; 95% CI, 0.74 to 1.10; P = .316; P heterogeneity = .495). In the subgroup analyses, the addition of carboplatin to pemetrexed in patients with squamous tumors led to a statistically significant improvement in OS from 5.4 to 9 months (adjusted HR, 0.58; 95% CI, 0.37 to 0.91; P interaction test = .039). Conclusion Second-line treatment of advanced NSCLC with pemetrexed plus carboplatin does not improve survival outcomes as compared with single-agent pemetrexed. The benefit observed with carboplatin addition in squamous tumors may warrant further investigation.
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Affiliation(s)
- Andrea Ardizzoni
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Marcello Tiseo
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Luca Boni
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Andrew D. Vincent
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Rodolfo Passalacqua
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Sebastiano Buti
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Domenico Amoroso
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Andrea Camerini
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Roberto Labianca
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Giovenzio Genestreti
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Corrado Boni
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Libero Ciuffreda
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Francesco Di Costanzo
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Filippo de Marinis
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Lucio Crinò
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Antonio Santo
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Antonio Pazzola
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Fausto Barbieri
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Nicoletta Zilembo
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Ida Colantonio
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Carmelo Tibaldi
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Rodolfo Mattioli
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Mara A. Cafferata
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Roberta Camisa
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
| | - Egbert F. Smit
- Andrea Ardizzoni, Marcello Tiseo, and Roberta Camisa, Azienda Ospedaliero-Universitaria, Parma; Luca Boni and Francesco Di Costanzo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Rodolfo Passalacqua and Sebastiano Buti, Ospedale Civile, Cremona; Domenico Amoroso and Andrea Camerini, Ospedale della Versilia, Lido di Camaiore; Roberto Labianca, Ospedali Riuniti, Bergamo; Giovenzio Genestreti, Istituto Oncologico Romagnolo, Meldola; Corrado Boni, Ospedale Santa Maria Nuova, Reggio Emilia; Libero
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Huang Y, Liu Y, Zhou J, Xu N, Li B, Wu G, Fang J, Li K, Liu X, Liu W, Lu Y, Wang M, Liu W, Liang H, Zhang Y, Huang C, Wang S, Wang Y, Yu S, Chang J, Wang Z, Hu Z, Zhang L. [A randomized, controlled, multicenter clinical trial comparing pemetrexed/cisplatin and gemcitabine/cisplatin as first-line treatment for advanced nonsquamous non-small cell lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2012; 15:576-82. [PMID: 23075681 PMCID: PMC5999831 DOI: 10.3779/j.issn.1009-3419.2012.10.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
背景与目的 目前晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)的标准治疗仍是含铂两药方案,国内外多项临床研究显示培美曲塞联合顺铂在晚期非鳞NSCLC具有较好的疗效及安全性,本研究拟评估国产培美曲塞二钠联合顺铂一线治疗晚期NSCLC的疗效与安全性。 方法 本研究是一项多中心、随机、阳性药物平行对照的临床试验。入组患者按1:1随机分为两组,分别接受培美曲塞二钠联合顺铂(PC组)或吉西他滨联合顺铂(GC组)治疗,21天为一个周期。主要研究终点为无进展生存期,次要研究终点主要包括1年生存率、客观缓解率、无3度或4度毒性生存期及其安全性。 结果 全国20家研究中心共纳入288例患者(各组144例),基于全分析集进行分析,PC组与GC组患者的中位无进展生存期分别为168天(5.6个月)和140天(4.7个月)(P=0.16);1年生存率分别为50.0%和54.9%(P=0.47);客观缓解率分别为24.4%和14.2%(P=0.06);无3度/4度毒性生存期分别为11.3个月和8.1个月(P=0.23)。总体不良反应发生率PC组明显低于GC组(81.95% vs 93.75%, P=0.003)。 结论 两种含铂方案治疗晚期非鳞NSCLC具有相似的疗效,但PC方案不良反应更轻,有望成为晚期非鳞NSCLC一线治疗的新选择。
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Affiliation(s)
- Yan Huang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
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Handorf EA, McElligott S, Vachani A, Langer CJ, Bristol Demeter M, Armstrong K, Asch DA. Cost effectiveness of personalized therapy for first-line treatment of stage IV and recurrent incurable adenocarcinoma of the lung. J Oncol Pract 2012; 8:267-74. [PMID: 23277762 PMCID: PMC3439225 DOI: 10.1200/jop.2011.000502] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2012] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Patients with epidermal growth factor receptor (EGFR) mutation-positive stage IV adenocarcinoma have improved survival with tyrosine kinase inhibitor (TKI) treatments, but the cost effectiveness of personalized first-line therapy using EGFR mutation testing is unknown. METHODS We created a decision analytic model comparing the costs and effects of platinum combination chemotherapy with personalized therapy in which patients with EGFR mutation-positive tumors were treated with erlotinib. We used two testing strategies: testing only those with tissue available and performing a repeat biopsy if tissue was not available versus three nontargeted chemotherapy regimens (ie, carboplatin and paclitaxel; carboplatin and pemetrexed; and carboplatin, pemetrexed, and bevacizumab). RESULTS Compared with a carboplatin plus paclitaxel regimen, targeted therapy based on testing available tissue yielded an incremental cost-effectiveness ratio (ICER) of $110,644 per quality-adjusted life year (QALY), and the rebiopsy strategy yielded an ICER of $122,219 per QALY. Probabilistic sensitivity analysis revealed substantial uncertainty around these point estimates. With a willingness to pay of $100,000 per QALY, the testing strategy was cost effective 58% of the time, and the rebiopsy strategy was cost effective 54% of the time. Personalized therapy with an EGFR TKI was more favorable when the nontargeted chemotherapy regimen was more expensive. Compared with carboplatin, pemetrexed, and bevacizumab, ICERs were $25,547 per QALY for the testing strategy and $44,036 per QALY for the rebiopsy strategy. CONCLUSION Although specific clinical circumstances should guide therapy, our cost-effectiveness analysis supports the strategy of testing for EGFR mutations in patients with stage IV or recurrent adenocarcinoma of the lung, rebiopsying patients if insufficient tissue is available for testing, and treating patients with EGFR mutations with erlotinib as first-line therapy.
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Affiliation(s)
- Elizabeth A Handorf
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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Li M, Zhang Q, Fu P, Li P, Peng A, Zhang G, Song X, Tan M, Li X, Liu Y, Wu Y, Fan S, Wang C. Pemetrexed plus platinum as the first-line treatment option for advanced non-small cell lung cancer: a meta-analysis of randomized controlled trials. PLoS One 2012; 7:e37229. [PMID: 22615946 PMCID: PMC3355109 DOI: 10.1371/journal.pone.0037229] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 04/16/2012] [Indexed: 11/18/2022] Open
Abstract
To compare the efficacy and toxicities of pemetrexed plus platinum with other platinum regimens in patients with previously untreated advanced non-small cell lung cancer (NSCLC). Methods: A meta-analysis was performed using trials identified through PubMed, EMBASE, and Cochrane databases. Two investigators independently assessed the quality of the trials and extracted data. The outcomes included overall survival (OS), progression-free survival (PFS), response rate (RR), and different types of toxicity. Hazard ratios (HRs), odds ratios (ORs) and their 95% confidence intervals (CIs) were pooled using RevMan software. Results: Four trials involving 2,518 patients with previously untreated advanced NSCLC met the inclusion criteria. Pemetrexed plus platinum chemotherapy (PPC) improved survival compared with other platinum-based regimens (PBR) in patients with advanced NSCLC (HR = 0.91, 95% CI: 0.83–1.00, p = 0.04), especially in those with non-squamous histology (HR = 0.87, 95% CI: 0.77–0.98, p = 0.02). No statistically significant improvement in either PFS or RR was found in PPC group as compared with PBR group (HR = 1.03, 95% CI: 0.94–1.13, p = 0.57; OR = 1.15, 95% CI: 0.95–1.39, p = 0.15, respectively). Compared with PBR, PPC led to less grade 3–4 neutropenia and leukopenia but more grade 3–4 nausea. However, hematological toxicity analysis revealed significant heterogeneities. Conclusion: Our results suggest that PPC in the first-line setting leads to a significant survival advantage with acceptable toxicities for advanced NSCLC patients, especially those with non-squamous histology, as compared with other PRB. PPC could be considered as the first-line treatment option for advanced NSCLC patients, especially those with non-squamous histology.
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Affiliation(s)
- Ming Li
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Qian Zhang
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Peifang Fu
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Ping Li
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Aimei Peng
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Guoliang Zhang
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Xiaolian Song
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Min Tan
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Xuan Li
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Yang Liu
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Yueping Wu
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Suyun Fan
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Changhui Wang
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
- * E-mail:
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Phase I Study of Pemetrexed, Cisplatin, and Concurrent Radiotherapy in Patients With Locally Advanced Non-small Cell Lung Cancer. Am J Clin Oncol 2012; 35:115-9. [DOI: 10.1097/coc.0b013e318209ab93] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bailon O, Chouahnia K, Augier A, Bouillet T, Billot S, Coman I, Ursu R, Belin C, Zelek L, Des Guetz G, Levy C, Carpentier AF, Morere JF. Upfront association of carboplatin plus pemetrexed in patients with brain metastases of lung adenocarcinoma. Neuro Oncol 2012; 14:491-5. [PMID: 22362813 DOI: 10.1093/neuonc/nos004] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Approximately 10% of patients with non-small cell lung cancer (NSCLC) have brain metastases at the time of diagnosis. When surgical resection is not possible, whole brain radiotherapy is the standard of care, with a cerebral response rate of approximately 30%. We report our experience with an upfront association of carboplatin and pemetrexed (areas under the curve, 5 and 500 mg/m(2), respectively), every 3 weeks, in 30 patients presenting with newly diagnosed brain metastases and NSCLC. Cerebral MRIs were performed every 6-9 weeks. The radiologic response rates were assessed according to Response Evaluation Criteria in Solid Tumors. Overall survival was also determined. Twenty-six patients were evaluable for response, and the objective cerebral response rate (complete and partial response) in the intent-to-treat population was 40% (12 of 30 patients). Event-free survival was 31 weeks, and median overall survival was 39 weeks. The upfront association of carboplatin plus pemetrexed allows simultaneous treatment of cerebral and systemic disease in patients with NSCLC with newly diagnosed brain metastases and appears to be particularly interesting in terms of radiologic response and overall survival. Further clinical studies are warranted.
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Affiliation(s)
- Olivier Bailon
- Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Neurologie, France
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A Randomized Phase 3 Trial Comparing Pemetrexed/Carboplatin and Docetaxel/Carboplatin as First-Line Treatment for Advanced, Nonsquamous Non-small Cell Lung Cancer. J Thorac Oncol 2011; 6:1907-14. [DOI: 10.1097/jto.0b013e318226b5fa] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Zhang XX, Huang MJ, Gong YL, Zhou L, Liu YM, Zhu J. A retrospective study of pemetrexed combined with oxaliplatin as second-line treatment for advanced non-small-cell lung cancer: Comparable toxicity, better outcome. Thorac Cancer 2011; 2:201-206. [PMID: 27755843 DOI: 10.1111/j.1759-7714.2011.00073.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The outcomes of single-agent regimens as second-line chemotherapy for metastatic non-small-cell lung cancer (NSCLC) are poor. Pemetrexed combined with oxaliplatin has been reportedly well-tolerated and active in chemotherapy-naïve NSCLC. The current study aimed to evaluate the therapeutic effect and toxicity of the regimen of pemetrexed plus oxaliplatin for pretreated advanced NSCLC. PATIENTS AND METHODS The clinical records of consecutive patients with metastatic NSCLC who received pemetrexed after failed first-line chemotherapy were reviewed. RESULTS The medical records of 79 eligible patients were examined. Thirty-four of them were treated with a regimen of pemetrexed plus oxaliplatin (PEMOX). Another 45 patients were administered pemetrexed alone (PEM). Both regimens were well-tolerated and there was no therapy-related death. Comparable response rates (15.2% vs. 11.1%) and tumor control rates (63.6% vs. 47.5%) were observed between the two groups. Median time to progression and overall survival of the PEMOX and PEM groups were 18 weeks (95% confidence interval (CI): 13.72-22.28 weeks) versus 13 weeks (95%CI: 12.28-13.72 weeks; P= 0.002), and 31 weeks (95%CI: 15.56-46.44 weeks) versus 21 weeks (95%CI: 18.37-23.63 weeks; P= 0.006), respectively. CONCLUSIONS The current retrospective study suggests that pemetrexed combined with oxaliplatin as second-line treatment for advanced NSCLC has comparable safety and response with a pemetrexed alone regimen, but better survival.
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Affiliation(s)
- Xin-Xing Zhang
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Mei-Juan Huang
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - You-Ling Gong
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Zhou
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Yong-Mei Liu
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiang Zhu
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
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Felip E, Rosell R. Pemetrexed as second-line therapy for advanced non-small-cell lung cancer (NSCLC). Ther Clin Risk Manag 2011; 4:579-85. [PMID: 18827853 PMCID: PMC2500250 DOI: 10.2147/tcrm.s2248] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
NSCLC accounts for 80% of all cases of lung cancer, which is the leading cause of cancer mortality. The majority of NSCLC patients present with advanced, unresectable disease, which remains incurable. In advanced disease, chemotherapy with platinum (cisplatin or carboplatin) in combination with a third-generation cytotoxic drug (vinorelbine, gemcitabine, paclitaxel, or docetaxel) can provide a modest improvement in survival without impairing quality of life. In chemotherapy-naïve, advanced, non-squamous NSCLC patients, the combination of bevacizumab with chemotherapy was shown to produce better outcomes than chemotherapy alone. Response rates of 20%–40% can now be expected, with a median survival of 8–11 months and a 1-year survival rate of 30%–40%. In second-line treatment, docetaxel has shown superiority to best supportive care in terms of survival and quality of life. A pooled analysis comparing docetaxel administered weekly versus 3-weekly found similar survival rates between the schedules and a non-significant reduction in febrile neutropenia for the weekly regimen. Pemetrexed, a multitargeted antifolate agent, has shown clear activity in several tumors, including mesothelioma and NSCLC. In a phase III trial, second-line treatment with pemetrexed demonstrated overall survival comparable to docetaxel, with a more manageable toxicity profile.
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Wu SG, Yang CH, Yu CJ, Lee JH, Hsu YC, Chang YL, Shih JY, Yang PC. Good response to pemetrexed in patients of lung adenocarcinoma with epidermal growth factor receptor (EGFR) mutations. Lung Cancer 2011; 72:333-9. [PMID: 21111508 DOI: 10.1016/j.lungcan.2010.10.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 10/17/2010] [Accepted: 10/24/2010] [Indexed: 10/18/2022]
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Metro G, Chiari R, Mare M, Giannarelli D, Tofanetti FR, Minotti V, Ferraldeschi M, Giuffrida D, Marcomigni L, Bennati C, Fischer MJ, Meacci M, Bellavita R, Pistola L, Ludovini V, Crinò L. Carboplatin plus pemetrexed for platinum-pretreated, advanced non-small cell lung cancer: a retrospective study with pharmacogenetic evaluation. Cancer Chemother Pharmacol 2011; 68:1405-12. [DOI: 10.1007/s00280-011-1632-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 03/21/2011] [Indexed: 10/18/2022]
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Randomized, phase II trial of pemetrexed and carboplatin with or without enzastaurin versus docetaxel and carboplatin as first-line treatment of patients with stage IIIB/IV non-small cell lung cancer. J Thorac Oncol 2011; 5:1963-9. [PMID: 21102260 DOI: 10.1097/jto.0b013e3181fd42eb] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Enzastaurin is an oral serine/threonine kinase inhibitor that targets protein kinase C-beta (PKC-β) and the phosphatidylinositol-3-kinase/AKT pathway. This trial assessed pemetrexed-carboplatin ± enzastaurin to docetaxel-carboplatin in advanced non-small cell lung cancer. METHODS Patients with stage IIIB (with pleural effusion) or IV non-small cell lung cancer and performance status 0 or 1 were randomized to one of the three arms: (A) pemetrexed 500 mg/m and carboplatin area under the curve 6 once every 3 weeks for up to 6 cycles with a loading dose of enzastaurin 1125 or 1200 mg followed by 500 mg daily until disease progression, (B) the same regimen of pemetrexed-carboplatin without enzastaurin, or (C) docetaxel 75 mg/m and carboplatin area under the curve 6 once every 3 weeks for up to six cycles. The primary end point was time to disease progression (TTP). RESULTS Between March 2006 and May 2008, 218 patients were randomized. Median TTP was 4.6 months for pemetrexed-carboplatin-enzastaurin, 6.0 months for pemetrexed-carboplatin, and 4.1 months for docetaxel-carboplatin (differences not significant). Median survival was 7.2 months for pemetrexed-carboplatin-enzastaurin, 12.7 months for pemetrexed-carboplatin, and 9.2 months for docetaxel-carboplatin (log-rank p = 0.05). Compared with the other arms, docetaxel-carboplatin was associated with lower rates of grade 3 thrombocytopenia and anemia but a higher rate of grade 3 or 4 febrile neutropenia. CONCLUSION There was no difference in TTP between the three arms, but survival was longer with pemetrexed-carboplatin compared with docetaxel-carboplatin. Enzastaurin did not add to the activity of pemetrexed-carboplatin.
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Randomized, double-blinded, multicenter, phase II study of pemetrexed, carboplatin, and bevacizumab with enzastaurin or placebo in chemonaïve patients with stage IIIB/IV non-small cell lung cancer: Hoosier Oncology Group LUN06-116. J Thorac Oncol 2011; 5:1815-20. [PMID: 20881647 DOI: 10.1097/jto.0b013e3181ee820c] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION : Bevacizumab is approved in combination with chemotherapy as first-line treatment for non-small cell lung cancer (NSCLC). Preclinical data suggest that enzastaurin and bevacizumab may have complementary effects in inhibiting angiogenesis. METHODS : ELIGIBILITY CRITERIA ≥18 years of age, chemonaïve, stage IIIB/IV nonsquamous NSCLC, and Eastern Cooperative Oncology Group performance status 0 to 1. Patients were randomized to placebo or enzastaurin 500 mg orally daily (after a loading dose), plus pemetrexed 500 mg/m, carboplatin area under the curve 6, and bevacizumab 15 mg/kg, intravenously, every 21 days for four cycles. Patients without progression received maintenance therapy with bevacizumab and placebo or enzastaurin. The primary objective was progression-free survival (PFS). Planned sample size was 90 patients, one-sided alpha of 0.20, with two interim analyses: one for safety and the second for futility, with a PFS hazard ratio of 0.8857. RESULTS : Forty patients were randomized. No unique safety concerns were noted at the first interim analysis. The early stopping rule for futility was met at the second interim analysis. Median PFS was 3.5 months and 4.3 months (hazard ratio: 1.04, 95% confidence interval: 0.49-2.21), and response rates were 20% and 30% (p = 0.462) for enzastaurin and placebo, respectively. Grade 3 or 4 toxicity was similar between the two arms. Two patients died on study because of respiratory arrest and pulmonary embolism. An additional patient died of sepsis secondary to a gastrointestinal perforation >30 days after study treatment discontinuation. CONCLUSIONS : Enzastaurin does not improve efficacy when combined with pemetrexed, carboplatin, and bevacizumab. This combination does not warrant further study in NSCLC.
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Safety and resource utilization by non-small cell lung cancer histology: results from the randomized phase III study of pemetrexed plus cisplatin versus gemcitabine plus cisplatin in chemonaïve patients with advanced non-small cell lung cancer. J Thorac Oncol 2011; 5:1602-8. [PMID: 20808252 DOI: 10.1097/jto.0b013e3181eaf30f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A prespecified analysis of the large, randomized, phase III study in advanced non-small cell lung cancer showed significant improvement in survival for nonsquamous patients treated with pemetrexed/cisplatin versus gemcitabine/cisplatin. Selected grade 3/4 toxicities and resource utilization favored pemetrexed in the overall population, but detailed safety results by histology have not been reported. METHODS Treated patients were included in this analysis of safety by histology. At each cycle, adverse events were assessed, and concomitant medications, transfusions, and hospitalizations were recorded. Measures were summarized by histology and compared between arms with Fisher's exact test. RESULTS When analyzed by squamous and nonsquamous histology, safety and resource utilization for each treatment arm paralleled those of the overall population. Selected toxicities did not vary by histology. Concomitant medication use and hospitalizations were also very similar to the patterns observed in the overall population. CONCLUSIONS Although previous efficacy analyses showed a significant pemetrexed treatment advantage for nonsquamous patients, results of this analysis indicate that safety and resource utilization do not vary by histology and are consistent with the overall population. The safety and resource utilization of patients treated with pemetrexed/cisplatin are predictable, reproducible, and consistent with the established favorable safety profile of pemetrexed, regardless of histology.
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Davies JM, Dhruva NS, Walko CM, Socinski MA, Bernard S, Hayes DN, Kim WY, Ivanova A, Keller K, Hilbun LR, Chiu M, Dees EC, Stinchcombe TE. A phase I trial of sorafenib combined with cisplatin/etoposide or carboplatin/pemetrexed in refractory solid tumor patients. Lung Cancer 2011; 71:151-5. [PMID: 20580118 PMCID: PMC2978774 DOI: 10.1016/j.lungcan.2010.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 05/25/2010] [Accepted: 05/30/2010] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Sorafenib has demonstrated single agent activity in non-small cell (NSCLC) and small cell lung cancer (SCLC). Carboplatin/pemetrexed (CbP) and cisplatin/etoposide (PE) are commonly used in the treatment of these diseases. METHODS A phase I trial escalating doses of sorafenib in combination with fixed doses of PE (Arm A) or CbP (Arm B) was performed using a 3-patient cohort design to determine the maximum tolerated dose (MTD) and dose-limiting toxicities (DLT); DLT were assessed in the first cycle. The trial was subsequently amended with closure of Arm B and to include Arm C with a reduced dose of carboplatin. RESULTS Between 9/2007 and 9/2008, 20 pts were treated on the trial; median age 62 (range 42-73), male/female ratio 12/8, PS 0/1 ratio 6/14, and median number of prior therapies 2 (range 1-4). The most common tumor types were NSCLC and SCLC. On Arm A at dose level 0 (sorafenib 200 mg BID), 2 of 4 patients experienced DLT; 2 patients were enrolled at dose level -1 (sorafenib 200 mg QD) without DLT, but this arm was closed due to slow accrual. On Arm B, 2 of 3 patients experienced DLT at dose level 0 (sorafenib 200 mg BID). On Arm C at dose level 0 (sorafenib 200 mg BID), 1 of 6 patients experienced DLT, and at dose level +1 (sorafenib 400 mg BID) 2 of 5 patients experienced a DLT. CONCLUSIONS The MTD of sorafenib was 200 mg BID continuously in combination with carboplatin (AUC of 5) and pemetrexed 500 mg/m² every 3 weeks. However, only 6 patients were treated at this dose level, and the results should be interpreted cautiously.
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Affiliation(s)
- Janine M. Davies
- Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Nirav S. Dhruva
- Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill
| | - Christine M. Walko
- UNC Eshelman School of Pharmacy, Institute of Pharmacogenomics and Individualized Therapy, University of North Carolina at Chapel Hill
| | - Mark A. Socinski
- Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Stephen Bernard
- Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - D. Neil Hayes
- Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - William Y. Kim
- Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Anastasia Ivanova
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Kimberly Keller
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Layla R. Hilbun
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Michael Chiu
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - E. Claire Dees
- Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Thomas E. Stinchcombe
- Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
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Wang W, Shang L, Li X, Li J, Wen F, Liu J. [Pemetrexed combined with cisplatin or carboplatin regimen in the treatment of advanced recurrent or metastasis non-small cell lung cancer: analysis of 63 cases]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2011; 14:54-7. [PMID: 21219833 PMCID: PMC5999704 DOI: 10.3779/j.issn.1009-3419.2011.01.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE Since the poor outcome for advanced lung cancer with first-line chemotherapy, more efforts should be paid for treatment of advanced recurrent or metastasis non-small cell lung cancer (NSCLC) patients. Pemetrexed, as a multi-target antifolate chemotherapeutic drug, was approved for the second-line treatment of advanced NSCLC. The aim of this study is to evaluate the efficacy and side effects of pemetrexed combined with cisplatin/carboplatin in the treatment of advanced recurrent or metastasis NSCLC. METHODS Sixty-three advanced recurrent or metastasis NSCLC patients confirmed with pathology or cytology were enrolled in this study. Among them, 40 cases were male and 23 were female, with 62 years of median age. The combination regimen was patients received pemetrexed 500 mg/m² on day 1 and cisplatin 30 mg/m² on day 1, day 2 and day 3 or carboplatin 300 mg/m² on day 1 by intravenous infusion, with 21 days as one cycle. All patients who received 2 or more cycles could be evaluated. RESULTS Only 1 case got complete response, with 5 cases partial response, 36 stable and 21 cases progressive. The overall control rate was 66.7% (42/63). The median survival time was 9.0 months, while the median progression-free survival was 5.0 months (3.0 months in squamous cell carcinoma; 5.5 months in adenocarcinoma). There was a significant difference between squamous cell carcinoma and adenocarcinoma (P=0.017). The common adverse effects were leucopenia, anemia and gastrointestinal response. CONCLUSIONS Pemetrexed combined with cisplatin/carboplatin is effective and feasible for advanced recurrent or metastasis NSCLC.
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Affiliation(s)
- Wei Wang
- Department of Thoracic Surgery, Naval General Hospital of PLA, Beijing, China.
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Okamoto I, Takeda K, Daga H, Miyazaki M, Yonesaka K, Kiyota H, Tsurutani J, Ueda S, Ichikawa Y, Takeda M, Sekiguchi R, Tominaga K, Enatsu S, Nambu Y, Nakagawa K. Dose-escalation study of pemetrexed in combination with carboplatin followed by pemetrexed maintenance therapy for advanced non-small cell lung cancer. Lung Cancer 2010; 70:168-73. [DOI: 10.1016/j.lungcan.2010.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Revised: 02/16/2010] [Accepted: 02/18/2010] [Indexed: 10/19/2022]
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Kim HS, Lee GW, Kim JH, Kim HY, Kwon JH, Song HH, Kim HJ, Jung JY, Jang G, Choi DR, Park SM, Shin TR, Lee HS, Zang DY. A phase II study of pemetrexed and carboplatin as a salvage therapy for platinum-pretreated patients with non-small cell lung cancer. Lung Cancer 2010; 70:71-6. [DOI: 10.1016/j.lungcan.2009.12.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 12/18/2009] [Accepted: 12/26/2009] [Indexed: 11/15/2022]
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Zinner RG, Saxman SB, Peng G, Monberg MJ, Ortuzar WI. Treatment Rationale and Study Design for a Randomized Trial of Pemetrexed/Carboplatin Followed by Maintenance Pemetrexed Versus Paclitaxel/Carboplatin/Bevacizumab Followed by Maintenance Bevacizumab in Patients With Advanced Non–Small-Cell Lung Cancer of Nonsquamous Histology. Clin Lung Cancer 2010; 11:352-7. [DOI: 10.3816/clc.2010.n.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Malhotra B, Evans T, Weiss J, Eaby B, Stonehouse-Lee S, Sherry V, Langer CJ. Carboplatin/pemetrexed/bevacizumab in the treatment of patients with advanced non-small-cell lung cancer: a single-institution experience. Clin Lung Cancer 2010; 11:192-7. [PMID: 20439196 DOI: 10.3816/clc.2010.n.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to determine the efficacy and tolerability of carboplatin, pemetrexed, and bevacizumab in patients with advanced, nonsquamous non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS The charts of consecutive patients with stage IIIB/IV nonsquamous NSCLC were reviewed. All patients receiving at least 1 cycle of the 3-drug regimen (pemetrexed 500 mg/m2, carboplatin area under the curve of 5-6, bevacizumab 15 mg/kg intravenously), were included for assessment of response, safety, and toxicity. RESULTS A total of 27 patients received this regimen between February 2008 and July 2009; 63% were women. Median follow-up was 6.3 months (range, 1.6-21.1 months). Median number of cycles was 6 (range, 1-6 cycles); 67% completed 6 cycles; 83% went on to receive maintenance bevacizumab/pemetrexed. Among those who received maintenance, the median number of cycles administered was 4.5 (range, 1-18 cycles). Response rate was 52%; stable disease was observed in another 40%. On the basis of Kaplan-Meier analysis, actuarial overall survival was 83% at 12 months; actuarial progression-free survival was 83% and 63% at 6 and 12 months, respectively. Clinical improvement was noted in 41% of the patients, with clinical stability in another 48%. Grade 2 and 3 toxicities from the regimen included anemia (11% and 15%), fatigue (37% and 7.4%), febrile neutropenia (7.4%; grade 3 only), thrombocytopenia (7.4% and 0), and thromboembolic disorders (3.7% and 3.7%). Bevacizumab-induced side effects (any grade) included headaches (22.2%), epistaxis (30%), hemoptysis (3.7%), and hypertension (11%). No grade 4 or 5 toxicities were seen. CONCLUSION Combination carboplatin/pemetrexed and bevacizumab followed by maintenance therapy with pemetrexed/bevacizumab is effective, with response rates > 50%, acceptable toxicity, and promising early survival in patients with advanced nonsquamous NSCLC.
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Affiliation(s)
- Binu Malhotra
- Division of Thoracic Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104 , USA
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Fuld AD, Dragnev KH, Rigas JR. Pemetrexed in advanced non-small-cell lung cancer. Expert Opin Pharmacother 2010; 11:1387-402. [PMID: 20446853 DOI: 10.1517/14656566.2010.482560] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IMPORTANCE OF THE FIELD Current therapeutic options for advanced non-small-cell lung cancer (NSCLC) yield relatively modest improvements in survival leading to an ongoing search for new active treatment agents. In the past decade, pemetrexed has had an increasingly established role in the treatment of advanced NSCLC in both first- and second-line settings. AREAS COVERED IN THIS REVIEW Currently available published data on mechanism of action, pharmacokinetics, safety and efficacy of pemetrexed in the treatment of advanced NSCLC are described. Peer-reviewed publications on the development of pemetrexed and its clinical use in NSCLC were reviewed (1995 - 2009). WHAT THE READER WILL GAIN Pemetrexed is a multitargeted antifolate cytotoxic agent. Key Phase II and Phase III trials are described that have shown pemetrexed's efficacy in both the first- and second-line treatment of advanced NSCLC. The efficacy of pemetrexed seems to vary between squamous and nonsquamous histologies. Possible reasons for this are explored. Additionally, the potential role of pemetrexed in maintenance therapy is discussed. TAKE HOME MESSAGE Pemetrexed is an effective treatment for advanced NSCLC, with an overall favorable toxicity profile. There is growing evidence that, in patients treated with pemetrexed, nonsquamous tumors have improved outcomes compared to squamous cell tumors. Pemetrexed may also have a role in maintenance therapy for NSCLC.
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Affiliation(s)
- Alexander D Fuld
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
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Zinner RG, Novello S, Peng G, Herbst R, Obasaju C, Scagliotti G. Comparison of patient outcomes according to histology among pemetrexed-treated patients with stage IIIB/IV non-small-cell lung cancer in two phase II trials. Clin Lung Cancer 2010; 11:126-31. [PMID: 20199979 DOI: 10.3816/clc.2010.n.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Recent phase III studies in advanced non-small-cell lung cancer (NSCLC) have demonstrated differential efficacy for pemetrexed according to NSCLC histology. The results of 2 phase II studies of pemetrexed and a platinum agent (carboplatin or oxaliplatin) were pooled to determine whether outcomes in the studies differed by tumor histology. PATIENTS AND METHODS Chemotherapy-naive patients with stage IIIB/IV NSCLC received pemetrexed 500 mg/m2 plus carboplatin area under the curve of 6 (n = 89) or pemetrexed 500 mg/m2 plus oxaliplatin 120 mg/m2 (n = 41); both regimens were administered every 21 days. The primary endpoint of both trials was response rate. Treatment arms were pooled, and Cox models with main effects for squamous histology were used to assess overall survival and progression-free survival. Cofactor adjustments incorporated terms for performance status, disease stage, and sex. RESULTS More than three quarters of enrolled patients had a nonsquamous histology. Mean age was 59.9 years for patients with nonsquamous histology and 63.7 years for patients with squamous histology. Response rates were 30% for patients with nonsquamous histology and 17.2% for patients with squamous histology. Overall survival was 10.5 months for patients with nonsquamous histology and 9.8 months for patients with squamous histology (hazard ratio [HR], 0.95; 95% CI, 0.52-1.74). Progression-free survival was 5.6 months for patients with nonsquamous histology and 4.7 months for patients with squamous histology (HR, 0.72; 95% CI, 0.43-1.19). CONCLUSION In patients treated with pemetrexed/ platinum doublets, nonsquamous histology was associated with better outcomes. The benefit of pemetrexed treatment among patients with nonsquamous histology is consistent with the results reported from previous studies.
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Affiliation(s)
- Ralph G Zinner
- The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
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