A Dose Escalation Study of Gemcitabine plus Pemetrexed Administered Biweekly in Patients with Solid Tumors

Pemetrexed for ovarian cancer: a systematic review of the published literature and a consecutive series of patients treated in a nonclinical trial setting

Objective

To gain a better understanding of the role of pemetrexed in ovarian cancer patients, we conducted a systematic review of the published literature and evaluated a consecutive, single-institution series of non-study pemetrexed-treated patients.

Methods/Results

Thirteen published articles met this study's eligibility criteria, providing a total of 376 unique and evaluable ovarian cancer patients. This systematic review demonstrated tumor response rates with pemetrexed-based chemotherapy from 9 to 84%; the agent appeared to be well tolerated. Similarly, 13 consecutive patients with ovarian, fallopian tube, or primary peritoneal cancer were treated with pemetrexed at the Mayo Clinic, Rochester, Minn., USA, from 2004 through 2013. The median number of previous chemotherapy regimens was 4; most patients received single-agent pemetrexed (n = 9). Patients received a median of 2 cycles of pemetrexed-based chemotherapy; 1 patient received 10 cycles (7 months’ worth) with treatment ongoing at the time of this report. The median survival from the start of pemetrexed was 4.8 months (95% confidence interval 1.2, 15 months). Two patients manifested a 50% drop in Ca-125 levels. Again, pemetrexed was relatively well tolerated.

Conclusion

Pemetrexed has antineoplastic activity in patients with ovarian cancer – even among those who have been heavily pretreated – and therefore merits further study.

Management of platinum-resistant ovarian cancer with the combination of pemetrexed and gemcitabine

INTRODUCTION

Platinum resistant ovarian cancer is a current challenge in Oncology. Current approved therapies offer no more of a 20% of response. New therapeutic options are urgently needed.

PATIENTS AND METHODS

Patients were treated with the combination of Pemetrexed 500 mg/m(2) d1 and Gemcitabine 1000 mg/m(2) d1,8 in a 21 days basis.

RESULTS

10 platinum-resistant ovarian cancer patients were treated under compassionate use. Mean previous chemotherapy lines were 3.3. Mean administered cycles were 4. Mean CA 125 decrease was on average of 47%, with one patient experiencing a 95% decrease in her CA 125 level. 1 patient had a complete clinical remission, and 2, had partial radiological responses. Mean Progression free survival was 16.5 weeks, and Overall Survival was 21.2 weeks. Treatment was well tolerated.

CONCLUSIONS

Deemd to the observed activity, the combination of Pemetrexed and Gemcitabine deserves deeper investigation in platinum-resistant ovarian cancer patients.