Chemotherapy with pemetrexed boosts survival in NSCLC | Latest news for doctors, nurses and pharmacists
As an adjunct to gefitinib monotherapy, pemetrexed-based chemotherapy improves survival outcomes in patients with non-small cell lung cancer (NSCLC) with EGFR mutations, according to a recent study.
From the PubMed, Web of Science, Cochrane and Embase databases, the researchers retrieved eight studies in five randomized clinical trials for pooled analysis. The outcomes of interest were overall survival (OS) and progression-free survival (PFS); objective response rate (ORR), disease control rate (DCR), and discontinuation rate (DR) were also assessed.
Compared to monotherapy, the combined approach significantly improved OS (relative risk [HR]0.57, 95% confidence interval [CI], 0.37–0.89; p=0.0125) and PFS (HR, 0.52, 95% CI, 0.39–0.79; p
The PFS benefit was pronounced in patients with the EGFR exon 19 deletion (HR, 0.50, 95% CI, 0.34-0.75; p=0.0008) and substitution of exon 21 L858R (HR, 0.46, 95% CI, 0.26-0.82; p=0.0079). These mutations had no significant impact on OS.
Complementary chemotherapy with pemetrexed also improved the ORR (odds ratio [OR], 1.91, 95% CI, 1.44–2.55; p
“The addition of pemetrexed-based chemotherapy to gefitinib could be given as a first-line treatment for patients with advanced EGFR mutant NSCLC,” the researchers said. “Future studies may lead to exploring more EGFR mutation subtypes amenable to TKI plus pemetrexed-based chemotherapy.”