Effectiveness and Safety of Pemetrexed Versus Docetaxel as a Treatment for Advanced Non-small Cell Lung Cancer: a Systematic Review and Meta-analysis

  • Di, Bao-Shan (The First Clinical Medical School of Lanzhou University) ;
  • Wei, Kong-Ping (Department of Pediatrics, the Second Hospital of Lanzhou University) ;
  • Tian, Jin-Hui (Evidence Based Medicine Center of Lanzhou University) ;
  • Xiao, Xiao-Juan (Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University) ;
  • Li, Yan (Department of Computer Science, Gansu Institute of Political Science and Law) ;
  • Zhang, Xu-Hui (Department of Geratology, The Affiliated Hospital of Gansu College of Traditional Chinese Medicine Lanzhou) ;
  • Yu, Qin (The First Clinical Medical School of Lanzhou University) ;
  • Yang, Ke-Hu (Evidence Based Medicine Center of Lanzhou University) ;
  • Ge, Long (Evidence Based Medicine Center of Lanzhou University) ;
  • Huang, Wen-Hui (Department of Nephrology, Gansu Provincial Hospital) ;
  • Zhang, Fang-Wa (Evidence Based Medicine Center of Lanzhou University)
  • Published : 2014.04.30


Background: Our aim was to conduct a meta-analysis to compare the efficacy and safety of pemetrexed and docetaxel for non-small cell lung cancer (NSCLC). Materials and Methods: We systematically searched the Cochrane Library, PubMed, Embase, China Biology Medicine Database for randomized controlled trials (RCTs) comparing the efficacy and toxicities of pemetrexed versus docetaxel as a treatment for advanced NSCLC. We limited the languages to English and Chinese. Two reviewers independently screened articles to identify eligible trials according to the inclusion and exclusion criteria and assessed the methodological quality of included trials, and then extracted data. The meta-analysis was performed using STATA12.0. Results: Six RCTs involving 1,414 patients were identified. We found that there was no statistically significant differences in overall response rate, survival time, progression-free survival, disease control rate, and 1-2yr survival rate (p>0.050) but it is worthy of mention that patients in the pemetrexed arms had significantly higher 3-yr survival rate (P=0.002). With regard to the grade 3 or 4 hematological toxicity, compared with docetaxel, pemetrexed led to lower rate of grade 3-4 febrile neutropenia, neutropenia, and leukocyts toxicity (p<0.001). There was no significant difference in anemia between the two arms (p=0.08). In addition, pemetrexed led to higher rate of grade 3-4 thrombocytopenia toxicity (p=0.03). As for the non-hematological toxicities, compared with docetaxel, pemetrexed group had lower rate of grade 3-4 diarrhea and alopecia. Conclusions: Pemetrexed was almost as effective as docetaxel in patients with advanced NSCLC. At the same time, pemetrexed might increase the 3-yr survival rate. As for safety, pemetrexed led to lower rate of grade 3-4 febrile neutropenia, neutropenia, leukocytes, diarrhea and alopecia toxicity. However, it was associated with a higher rate of grade 3-4 thrombocytopenia.


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