PURPOSE: Pemetrexed and platinum became one of the therapeutic options in advanced NSCLC in routine practice. It is recommended both in the 1st and 2nd line of chemotherapy.
METHODS: Results of the second line therapy in NSCLC with pemetrexed were evaluated in 10 centres. Data were prospectively collected from January 2008 to December 2010. Pemetrexed was routinely used in out-patients as a monotherapy. Demographics, tolerance of treatment and prognostic factors were discussed.
RESULTS: The series consisted of 389 patients(pts),247 men and 142 women,mean age was 61 years (28 -80),77 were non-smokers, 134 ex-smokers and 175 smokers. PS was 0 in 71 pts,1 in 278 pts, 2 in 40 pts. Adenocarcinoma was present in 236, squamous cell carcinoma in 83 pts,non specified NSCLC in 51 pts, large cell carcinoma in 19 pts. Side effects of treatment (Gr 3, 4) appeared in 113 (29.0%) pts. Therapeutic response: CR in 5 pts, PR in 43 pts, SD 136 pts and PD in 144 pts. Overall disease control was achieved in 47.4%. The median of overall survival (MOS) from the pemetrexed application was 9.8 months (8 m -11.6 m). It was 7.9 m in smokers and 11.8 m in non-smokers (p 0.048), 11.4 m in adenocarcinoma and 9.4 m in squamous cell carcinoma (p 0.048). MOS according to PS: NA in PS 0, 9.6 m in PS 1, 4.1 m in PS 2 (p 0.001). MOC according to stages: 10.6 m in stage I+II, 12.0 m in stage III and 9.2 m in stage IV (p 0.163). Median of progression free survival (PFS) was 2.7 m (2.4 m - 3.0 m), 2.5 m in smokers and 3.3 m in non-smokers (p 0.246), 2.6 m in adenocarcinoma and 3.1 m in squamous cell carcinoma (p 0.996). PFS according to PS: 3.6 m in PS 0, 2.6 m in PS 1, 1.4 m in PS 2 (p 0.001). PFF according to stages: 5.1 m in stage I+II, 2.8 in stage III and 2.4 in stage IV (p 0.157).
CONCLUSIONS: In present study pemetrexed was effective and well tolerable drug used in the second line chemotherapy of NSCLC treatment. MOS was significantly longer in PS 0 and 1 than in PS 2, in adenocarcinoma than in squamous carcinoma and in non-smokers than in smokers. PFS was not influenced by any evaluated parameter except of PS.
CLINICAL IMPLICATIONS: Safety and effectivity of pemetrexed monotherapy protocol in the second line chemotherapy of non small cell lung cancer was confirmed during 2 years follow-up in 10 centres in the Czech republic.
DISCLOSURE: The following authors have nothing to disclose: Vitezslav Kolek, Jaromir Roubec, Milos Pesek, Ivona Grygarkova, Petr Zatloukal, Jana Skrickova, Rostislav Vyzula, Leona Koubkova, Frantisek Salajka, Dimka Sixtova, Lubos Petruzelka, Michal Sticha
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