Clinical Observation and Prognostic Analysis of Pemetrexed plus Platinum as First-line Treatment in Patients with Advanced Non-small Cell Lung Cancer

  • Wang, Ji-Ying (Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine) ;
  • Cai, Yong (Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine)
  • Published : 2013.11.30


Objective: To determine clinical efficacy, safety and prognostic factors of pemetrexed plus platinum as first-line treatment in patients with advanced non-small cell lung cancer (NSCLC). Materials and Methods: Clinical characteristics, short-term efficacy, survival and adverse reactions of 47 advanced non-squamous NSCLC patients who had received pemetrexed plus platinum as first-line treatment in Shanghai Pulmonary Hospital from January 2009 to June 2011 were retrospectively analyzed. The Chi-squared test was applied to statistically analyze the overall response rate (ORR), disease control rate (DCR) and toxicity reactions in both groups, while survival data wereanalyzed by Kaplan-Meier and logrank methods, and the COX proportional hazards model was adopted for a series of multi-factor analyses. Results: Only two patients were lost to follow-up. The ORR, DCR, medium progression-free survival time (PFS) and medium overall survival (OS) were 31.9%, 74.5%, 5 months and 15.2 months, while 1- and 2-year survival rates were 63.8% (30/47) and 19.2% (9/47), respectively. Single-factor analysis showed that tumor pathological patterns and efficacy were in association with medium PFS (P<0.05), whereas tumor pathological patterns, smoking history and efficacy were closely connected with medium OS (P<0.05). Multi-factor analyses demonstrated that pathological patterns and efficacy were independent factors influencing OS (P<0.05). The rate of toxicity reactions in degree III/IV was low, including hematologic toxicity marked by decline in white blood cell count and decrease in the platelet count (PLT), and non-hematologic toxicity manifested by gastrointestinal reactions, such as nausea and vomiting. Conclusions: Pemetrexed plus platinum as first-line treatment has excellent efficacy and slight adverse reactions with favorable drug-tolerance in patients with advanced non-squamous NSCLC.


Tumor;non-small cell lung cancer;chemotherapy


  1. Altavilla G, Santarpia M, Arrigo C, et al (2010). EML4-ALK fusion gene in lung adenocarcinoma: a retrospective analysis of the outcome of cisplatin plus pemetrexed treated patients. J Clin Oncol, 28, 7610.
  2. Ciuleanu T, Brodowicz T, Zielinski C, et al (2009). Maintenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer: a randomised, double-blind, phase 3 study. Lancet, 374, 1432-40.
  3. Chang GC, Tsai CM, Hsia TC, et al (2013). Second-line pemetrexed treatment in Taiwanese patients with advanced nonsmall cell lung cancer: an open-label single-arm study. J Formos Med Assoc, 112, 518-26.
  4. Deng QQ, Huang XE, Ye LH, et al (2013). Phase II trial of Loubo (Lobaplatin) and pemetrexed for patients with metastatic breast cancer not responding to anthracycline or taxanes. Asian Pac J Cancer Prev, 14, 413-7.
  5. Camidge DR, Kono SA, Lu X, et al (2011). Anaplastic lymphoma kinase gene rearrangements in non-small cell lung cancer are associated with prolonged progression-free survival on pemetrexed. J Thoracic Oncology, 6, 774-80.
  6. de Marinis F, Passaro A, Clarke S (2013). Vitamin supplementation in patients receiving pemetrexed for advanced non-small cell lung cancer. Lung Cancer, 82, 511.
  7. Duan JC, Wu MN, Zhao J, et al (2012). Clinical efficacy and predicative factors analysis of pemetrexed plus cisplatin in the first-line treatment of advanced non-small cell lung cancer. Chin J Tuberc Respir Dis, 35, 97-101.
  8. Ho C, Davies AM, Sangha RS, et al (2013). Phase I/II trial of pemetrexed plus nab-paclitaxel in advanced solid tumor patients with emphasis on non-small cell lung cancer. Invest New Drugs, 31, 1587-91.
  9. Hanna N, Shepherd FA, Fossella FV, et al (2004). Randomized phase III trial of pemetrexed versus docetaxel in patients with non-small-cell lung cancer previously treated with chemotherapy. J Clin Oncol, 22, 1589-97.
  10. Hattori Y, Satouchi M, Katakami N, et al (2013). A phase II study of pemetrexed in patients with previously heavily treated non-squamous non-small cell lung cancer (HANSHIN Oncology Group 001). Cancer Chemother Pharmacol, [Epub ahead of print].
  11. Hatakeyama Y, Kobayashi K, Nagano T, et al (2013). Synergistic effects of pemetrexed and amrubicin in non-small cell lung cancer cell lines: Potential for combination therapy. Cancer Lett, [Epub ahead of print].
  12. Hattori Y, Iwasaku M, Satouchi M, et al (2013). A Phase II Study of Pemetrexed in Chemotherapy-naive Elderly Patients Aged $\geq$75 years with Advanced Non-squamous Non-small-cell Lung Cancer (HANSHIN Oncology Group 003). Jpn J Clin Oncol, 43, 1184-9.
  13. Jeong-Ok Lee, Tae Min Kim, Se-Hoon Lee, et al (2011). Anaplastic Lymphoma Kinase Translocation: A Predictive Biomarker of Pemetrexed in Patients with Non-small Cell Lung Cancer. J Thorac Oncol, 6, 1474-80.
  14. Kim ES, Neubauer M, Cohn A, et al (2013). Docetaxel or pemetrexed with or without cetuximab in recurrent or progressive non-small-cell lung cancer after platinum-based therapy: a phase 3, open-label, randomised trial. Lancet Oncol, 14, 1326-36.
  15. Li CG, Huang XE, Xu L, et al (2012). Clinical application of serum tumor associated material (TAM) from non-small cell lung cancer patients. Asian Pac J Cancer Prev, 13, 301-4.
  16. Liu YC, Zhou SB, Gao F, et al (2013). Chemotherapy and late course three dimensional conformal radiotherapy for treatment of patients with stage III non- small cell lung cancer. Asian Pac J Cancer Prev, 14, 2663-5.
  17. Lu YY, Huang XE, Xu L, et al (2013). Potential predictors of sensitivity to pemetrexed as first-line chemotherapy for patients with advanced non-squamous NSCLCs. Asian Pac J Cancer Prev, 14, 2005-8.
  18. Pereira JR, Cheng R, Orlando M, et al (2013). Elderly Subset Analysis of Randomized Phase III Study Comparing Pemetrexed Plus Carboplatin with Docetaxel Plus Carboplatin as First-Line Treatment for Patients with Locally Advanced or Metastatic Non-Small Cell Lung Cancer. Drugs R D, [Epub ahead of print].
  19. Patel JD, Socinski MA, Garon EB, et al (2013). PointBreak: A Randomized Phase III Study of Pemetrexed Plus Carboplatin and Bevacizumab Followed by Maintenance Pemetrexed and Bevacizumab Versus Paclitaxel Plus Carboplatin and Bevacizumab Followed by Maintenance Bevacizumab in Patients With Stage IIIB or IV Nonsquamous Non-Small-Cell Lung Cancer. J Clin Oncol, 31, 4349-57.
  20. Scagliotti GV, Parikh P, von Pawel J, et al (2008). Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy- naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol, 26, 3543-51.
  21. Wang T, Chuan Pan C, Rui Yu J, et al (2013). Association between TYMS expression and efficacy of pemetrexed-based chemotherapy in advanced non-small cell lung cancer: a meta-analysis. PLoS One, 8, e74284.
  22. Yang CH, Simms L, Park K, et al (2010). Efficacy and safety of cisplatin/pemetrexed versus cisplatin/gemcitabine as first-line treatment in East Asian patient with advanced non-small cell lung cancer: results of an exploratory subgroup analysis of a phase III trial. J Thorac Oncol, 5, 688-95.

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