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Metzenmacher M, Kopp HG, Griesinger F, Reinmuth N, Sebastian M, Serke M, Waller CF, Thomas M, Eggert J, Schmid-Bindert G, Hoiczyk M, Christoph DC, Kimmich M, Deuß B, Seifert S, Held S, Schuler M, Herold T, Breitenbuecher F, Eberhardt WEE. A randomized, multicenter phase II study comparing efficacy, safety and tolerability of two dosing regimens of cisplatin and pemetrexed in patients with advanced or metastatic non-small-cell lung cancer. Ther Adv Med Oncol 2021; 13:1758835921996506. [PMID: 34104223 PMCID: PMC8164550 DOI: 10.1177/1758835921996506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Pemetrexed and cisplatin is a first-line standard in non-squamous non-small-cell lung cancer without targetable mutations. It became the backbone of checkpoint-inhibitor–chemotherapy combinations. Single high doses of cisplatin pose toxicity risks and require hyperhydration, potentially prolonging outpatient application. The aim of this study was to compare efficacy, safety and tolerability of split-dose cisplatin with the standard schedule. Methods: Patients with metastatic non-squamous non-small-cell lung cancer were randomly assigned to up to six 21-day cycles of pemetrexed 500 mg/m2 and cisplatin 75 mg/m2 on day 1 (arm A), or pemetrexed 500 mg/m2 (day 1) and cisplatin 40 mg/m2 (day 1 + 8, arm B), followed by pemetrexed maintenance. Primary endpoint was objective response rate. Secondary objectives were overall survival, progression-free survival, time to progression, treatment compliance, toxicity profile, and quality of life. Results: We enrolled 130 patients (129 evaluable). Median cycle numbers in A and B were six (1–6) and five (1–6). Dose intensities were comparable between arms. More patients in A received pemetrexed maintenance (24.2% versus 11.1%). With 16 (24.2%) in A and 19 (30.2%) patients in B achieving objective responses [odds ratio 0.74 (0.34–1.62), p = 0.55] the primary endpoint was met. Overall survival was not different between arms (median 14.4 versus 14.9 months); [HR = 1.07; (0.68–1.68), p = 0.78]. Median progression-free survival was 7.0 months in A and 6.2 months in B [HR = 1.63; (1.17–2.38); p = 0.01]. Adverse events of CTCAE grade ⩾3, particularly hematological, were more frequent in B. No difference in grade 4 and 5 infections between arms was noted. Treatment-related asthenia and nausea/vomiting of any grade were more frequent in A. Global health status, fatigue and constipation measured on day 1 of cycle 4 demonstrated superior scores in B. Conclusion: Pemetrexed and split-dose cisplatin is safe and effective. Advantages of split-dose cisplatin with regard to specific toxicities allow personalization of this important chemotherapy backbone. Trial Registration: European Clinical Trials Database (EudraCT) number 2011-001963-37.
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Affiliation(s)
- Martin Metzenmacher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Hans-Georg Kopp
- Department of Medical Oncology, University Medical Center Tuebingen, Tuebingen, Germany
| | - Frank Griesinger
- Department of Hematology and Medical Oncology, Pius-Hospital Oldenburg, University Medicine Oldenburg, Oldenburg, Germany
| | - Niels Reinmuth
- Department of Oncology, Department of Pulmonology, LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Martin Sebastian
- Department of Hematology and Medical Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - Monika Serke
- Department of Pulmonology, Lungenklinik Hemer, Hemer, Germany
| | - Cornelius Florian Waller
- Department of Medicine I, University Medical Center Freiburg, Faculty of Medicine, University Freiburg, Freiburg, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik, University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Jochen Eggert
- Practice of Medical Oncology and Hematology, Onkologische Praxis Moers, Moers, Nordrhein-Westfalen, Germany
| | | | - Mathias Hoiczyk
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Daniel Christian Christoph
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Martin Kimmich
- Department of Medical Oncology, University Medical Center Tuebingen, Tuebingen, Germany
| | - Burkhard Deuß
- ClinAssess GmbH, Clinical Research Organisation (CRO), Leverkusen, Germany
| | - Stephanie Seifert
- ClinAssess GmbH, Clinical Research Organisation (CRO), Leverkusen, Germany
| | - Swantje Held
- ClinAssess GmbH, Clinical Research Organisation (CRO), Leverkusen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Thomas Herold
- Department of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Frank Breitenbuecher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Wilfried Ernst Erich Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, Essen, Nordrhein-Westfalen, 45147, Germany
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Koba T, Minami S, Nishijima-Futami Y, Masuhiro K, Kimura H, Futami S, Yaga M, Mori M, Kagawa H, Uenami T, Kohmo S, Otsuka T, Yamamoto S, Komuta K, Kijima T. Phase II trial of induction chemotherapy of pemetrexed plus split-dose cisplatin followed by pemetrexed maintenance for untreated non-squamous non-small-cell lung cancer. Cancer Chemother Pharmacol 2018; 82:111-117. [PMID: 29728800 DOI: 10.1007/s00280-018-3598-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/01/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE We conducted a phase II trial to evaluate the efficacy and safety of induction chemotherapy of pemetrexed plus split-dose cisplatin followed by pemetrexed maintenance for advanced non-squamous non-small-cell lung cancer (NSCLC). METHODS Patients with advanced or recurrent untreated non-squamous NSCLC received split-dose cisplatin (40 mg/m2, days 1 and 8) plus pemetrexed (500 mg/m2, day 1) tri-weekly. After four cycles of induction, patients without disease progression received pemetrexed maintenance until disease progression or unacceptable toxicity. The primary endpoint was the 1-year survival rate. The secondary endpoints were progression-free survival (PFS), overall survival (OS), response in induction phase, and safety. RESULTS From February 2012 to September 2014, 53 assessable patients were enrolled in this study. Thirty-eight (71.7%) patients completed induction therapy, while 35 (66.0%) received maintenance therapy. The 1-year survival rate was 67.7%. The median PFS and OS were 5.3 and 18.6 months, respectively. The response rate and disease control rate (DCR) during the induction phase were 37.7 and 86.8%, respectively. Eight patients (15.1%) discontinued the therapy due to adverse events (AEs) during the induction phase, but both hematological and non-hematological AEs were infrequent. CONCLUSIONS Treatment with induction chemotherapy of pemetrexed plus split-dose cisplatin showed a promising 1-year survival rate, DCR, and transition rate into maintenance phase. This regimen is feasible and well-tolerated. A phase III study comparing this regimen with conventional tri-weekly regimen is warranted.
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Affiliation(s)
- Taro Koba
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Osaka, 543-0035, Japan.,Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Seigo Minami
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Osaka, 543-0035, Japan
| | - Yu Nishijima-Futami
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Osaka, 543-0035, Japan.,Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kentaro Masuhiro
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Osaka, 543-0035, Japan.,Department of Thoracic Malignancy, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino, 583-8588, Japan
| | - Hiromi Kimura
- Department of Thoracic Oncology, National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan.,Department of Internal Medicine, Osaka Hospital Anti-Tuberculosis Association, 2276-1 Neyagawa-kouen, Neyagawa, Osaka, 572-0854, Japan
| | - Shinji Futami
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Osaka, 543-0035, Japan.,Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Moto Yaga
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Osaka, 543-0035, Japan.,Department of Respiratory Medicine, NTT West Osaka Hospital, 2-6-40 Karasugatsuji, Tennoji-ku, Osaka, Osaka, 543-8922, Japan
| | - Masahide Mori
- Department of Thoracic Oncology, National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Hiroyuki Kagawa
- Department of Thoracic Oncology, National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Takeshi Uenami
- Department of Thoracic Oncology, National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Satoshi Kohmo
- Department of General Internal Medicine, Nissay Hospital, 6-3-8 Itachibori, Nishi-ku, Osaka, Osaka, 550-0012, Japan
| | - Tomoyuki Otsuka
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.,Department of Thoracic Oncology, National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan.,Department of Medical Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Oska, Osaka, 541-8567, Japan
| | - Suguru Yamamoto
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Osaka, 543-0035, Japan
| | - Kiyoshi Komuta
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Osaka, 543-0035, Japan
| | - Takashi Kijima
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan. .,Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
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