Pemetrexed Singlet Versus Nonpemetrexed-Based Platinum Doublet as Second-Line Chemotherapy after First-Line Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitor Failure in Non-small Cell Lung Cancer Patients with EGFR Mutations
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Purpose Platinum-based doublet chemotherapy is the treatment of choice for patients withnon-small cell lung cancer (NSCLC); however, the role of a platinum-based doublet assecond-line therapy after failure of an epidermal growth factor receptor (EGFR) tyrosinekinase inhibitor (TKI) for NSCLC patients has not yet been elucidated. The purpose of thisstudy was to compare the clinical efficacy of pemetrexed versus a platinum-based doubletas second-line therapy after failure of EGFR TKI used as first-line therapy for NSCLC patientswith EGFR mutations. Materials and MethodsWe designed a multicenter retrospective cohort study of 314 NSCLC patients with EGFRmutations who received an EGFR TKI as first-line palliative chemotherapy. Our analysisincluded 83 patients who failed EGFR TKI therapy and received second-line cytotoxicchemotherapy. ResultsForty-six patients were treated using a platinum-based doublet and 37 patients were treatedusing singlet pemetrexed. The overall response rates of patients receiving a platinum-baseddoublet and patients receiving pemetrexed were17.4% and 32.4%, respectively (p=0.111). The median progression-free survival (PFS) of patients receiving pemetrexed was significantlylonger than that of patients receiving a platinum-based doublet (4.2 months vs. 2.7months, respectively; p=0.008). The hazard ratio was 0.54 (95% confidence interval, 0.34to 0.86; p=0.009). ConclusionOur retrospective analysis found that second-line pemetrexed singlet therapy providedsignificantly prolonged PFS compared to second-line platinum-based doublet chemotherapyfor NSCLC patients with EGFRmutations who failed first-line EGFR TKI. Conduct of prospectivestudies for confirmation of our results is warranted.
Abstract
Purpose Platinum-based doublet chemotherapy is the treatment of choice for patients withnon-small cell lung cancer (NSCLC); however, the role of a platinum-based doublet assecond-line therapy after failure of an epidermal growth factor receptor (EGFR) tyrosinekinase inhibitor (TKI) for NSCLC patients has not yet been elucidated. The purpose of thisstudy was to compare the clinical efficacy of pemetrexed versus a platinum-based doubletas second-line therapy after failure of EGFR TKI used as first-line therapy for NSCLC patientswith EGFR mutations. Materials and MethodsWe designed a multicenter retrospective cohort study of 314 NSCLC patients with EGFRmutations who received an EGFR TKI as first-line palliative chemotherapy. Our analysisincluded 83 patients who failed EGFR TKI therapy and received second-line cytotoxicchemotherapy. ResultsForty-six patients were treated using a platinum-based doublet and 37 patients were treatedusing singlet pemetrexed. The overall response rates of patients receiving a platinum-baseddoublet and patients receiving pemetrexed were17.4% and 32.4%, respectively (p=0.111). The median progression-free survival (PFS) of patients receiving pemetrexed was significantlylonger than that of patients receiving a platinum-based doublet (4.2 months vs. 2.7months, respectively; p=0.008). The hazard ratio was 0.54 (95% confidence interval, 0.34to 0.86; p=0.009). ConclusionOur retrospective analysis found that second-line pemetrexed singlet therapy providedsignificantly prolonged PFS compared to second-line platinum-based doublet chemotherapyfor NSCLC patients with EGFRmutations who failed first-line EGFR TKI. Conduct of prospectivestudies for confirmation of our results is warranted.
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