EGFR Mutation Genotype Impact on the Efficacy of Pemetrexed in Patients with Non-squamous Non-small Cell Lung Cancer

  • Igawa, Satoshi (Department of Respiratory Medicine, Kitasato University School of Medicine) ;
  • Sato, Yuichi (School of Allied Health Sciences, School of Medicine, Kitasato University) ;
  • Ishihara, Mikiko (Department of Respiratory Medicine, Kitasato University School of Medicine) ;
  • Kasajima, Masashi (Department of Respiratory Medicine, Kitasato University School of Medicine) ;
  • Kusuhara, Seiichiro (Department of Respiratory Medicine, Kitasato University School of Medicine) ;
  • Nakahara, Yoshiro (Department of Respiratory Medicine, Kitasato University School of Medicine) ;
  • Otani, Sakiko (Department of Respiratory Medicine, Kitasato University School of Medicine) ;
  • Fukui, Tomoya (Department of Respiratory Medicine, Kitasato University School of Medicine) ;
  • Katagiri, Masato (School of Allied Health Sciences, School of Medicine, Kitasato University) ;
  • Sasaki, Jiichiro (Research and Development Center for New Medical Frontiers, School of Medicine, Kitasato University) ;
  • Masuda, Noriyuki (Department of Respiratory Medicine, Kitasato University School of Medicine)
  • Published : 2016.07.01


Background: Pemetrexed monotherapy has come to be recognized as one of the standard second-line therapies for advanced non-squamous non-small cell lung cancer (NSCLC). However, there have been no reports of studies that have evaluated the efficacy of pemetrexed according to type of active EGFR mutation, i.e., an exon 19 deletion or an L858R point mutation. Materials and Methods: The records of non-squamous NSCLC patients harboring an EGFR mutation who received pemetrexed monotherapy as a second or later line of chemotherapy at Kitasato University Hospital between March 2010 and October 2015 were retrospectively reviewed, and the treatment outcomes were evaluated. Results: The overall response rate and progression-free survival time (PFS) of the 53 patients with non-squamous NSCLC were 15.1% and 2.3 months, respectively. There were significant differences between the disease control rate (37.5% vs. 76.2%) and PFS time (1.8 months vs. 3.3 months) of the exon 19 deletion group and the L858R point mutation group, and a multivariate analysis identified type of EGFR mutation as well as performance status (PS) as independent predictors of PFS. Conclusions: The clinical data obtained in this study provided a valuable rationale for considering type of EGFR mutation as well as non-squamous histology as predictors of the efficacy of pemetrexed monotherapy.


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