Impact of Pemetrexed Addition to Gemcitabine- Oxaliplatin on Treatment Outcome of Advanced or Metastatic Non-Squamous Non-Small Cell Lung Cancer

Abstract

AIM Platinum-based doublets are the recommended standard first-line chemotherapy for stage IIIB/IV non-small-cell lung cancer (NSCLC). However, many studies have evaluated the benefit of using more intensive regimens that contain three cytotoxic agents. The aim of this study was to evaluate the benefits of adding pemetrexed to the combination of gemcitabine and oxaliplatin (GEMOX) in the management of non-squamous NSCLC.  

METHODS Twenty eight evaluable patients with stage IIIB or IV non-squamous NSCLC were randomized to receive GEMOX doublet alone or GEMOX with pemetrexed (GEMOXAP). Dosages were gemcitabine 1250 mg/m² day 1, 8; oxaliplatin 100 mg/m² day 1 and pemetrexed 500 mg/m² day 1 with recycling every 21 days. Evaluation for response, toxicity and survival was performed after each circle.

RESULTS Partial response was higher but non-significant in the GEMOXAP arm (43.8%) compared to the GEMOX group (33.3%). Also higher but non-significant in the GEMOXAP group than the GEMOX group were the rates of improvement of dyspnea, hemoptysis, metastatic bone pain; quality of life; median time to disease progression and overall survival. Toxicity profiles were similar in the two groups.

CONCLUSION Large prospective studies are needed to establish whether the higher response rate, progression-free and overall survivals after addition of  pemetrexed  to the combination of gemcitabine and oxaliplatin are statistically significant  in advanced non-squamous NSCLC.