[Efficacy and toxicity of pemetrexed or gemcitabine combined with cisplatin in the treatment of patients with advanced non-small cell lung cancer]

A Randomized Controlled Study of rhTPO and rhIL-11 for the Prophylactic Treatment of Chemotherapy-Induced Thrombocytopenia in Non-Small Cell Lung Cancer

Background: rhTPO and rhIL-11 are both recommended for the prophylactic treatment of chemotherapy-induced thrombocytopenia (CIT). However, there has been no head to head comparative study on the prophylactic administration of rhTPO and rhIL-11 to alleviate CIT in non-small cell lung cancer (NSCLC). Methods: In this open-label prospective multi-center phase II clinical trial, 108 NSCLC patients who experienced severe CIT after prior chemotherapy were randomized into study and control arms. Patients in the study arm were prophylactically administered rhTPO on day 2, day 4, day 6 and day 9 of the subsequent chemotherapy cycle, while patients in the control arm accepted prophylactic rhIL-11 from day 9 to day 15 of the subsequent chemotherapy cycle. Results: During the trial, the median time required for recovery of the platelet count to ≥ 75 × 10⁹/L was 3 days (range: 2-4) in the study arm and 4 days (range: 2-6) in the control arm (P = 0.398). The lowest platelet counts were 61.8 ± 39.9 × 10⁹/L in the study arm, values higher than those measured in the control arm 52.8 ± 36.8 × 10⁹/L (P = 1.044). Platelet counts < 50 × 10⁹/L occurred in 46.2% of patients in the study arm vs 58.6% in the control arm (P = 0.368). There were no drug-related adverse reactions in the study arm, but 4 cases (12.9%) in the control arm (P = 0.008), especially cardiotoxicity (P = 0.022). Conclusion: Prophylactic administration of rhTPO helps to alleviate CIT in NSCLC as well as rhIL-11, but is safer to use and more convenient to administer.

Randomized study of gefitinib versus pemetrexed as maintenance treatment in patients with advanced glandular non-small cell lung cancer

Gefitinib was compared with pemetrexed as maintenance therapy in Patients with Advanced Glandular Non-small Cell Lung Cancer, mainly regarding clinical effect and side effect. A randomized trial of pemetrexed as study group (500 mg/m(2), dl) versus gefitinib as the control group [250 mg on night 1, 250 mg on morning 2 (every day)] was conducted in 188 patients, 94 cases in each group with a therapy cycle of 21 days. In addition, the study group was also treated with folic acid, vitB12 and dexamethasone. Therapeutic effects and adverse reactions of the two groups were compared. Patients of two groups completed four cycles of chemotherapy mostly, and there was no complete remission (CR) case. The median-cycle of chemotherapy was 2 for the study group, and partial response (PR), stable disease (SD), progressive disease (PD) were observed in 28 (29.8%), 34 (36.2%), 32 (34.0%) cases respectively. The median-cycle was 3 for the control group, PR, SD and PD were observed in 17 (18.1%), 23 (24.5%), 54 (57.4%) cases respectively. The effective rates were 29.8% and 18.1% for pemetrexed (28 cases) and gefitinib (17 cases) respectively (P > 0.05). However, there was a statistically significant difference in disease control rates between the 2 groups (65.0% vs 42.6%; P < 0.05). Adverse reactions occurred in two groups were mainly mild adverse reactions of 1-2 degree, without renal failure. The study group and control group had three and five cases of mild infection respectively, without statistically significant difference. There was no significant difference in the incidence rate of rash and alopecia between the two groups (P > 0.05). However, the number of cases with neutropenia, anemia, thrombocytopenia, gastrointestinal reactions and fatigue in the study group was lower than that of the control group, with a statistically significant difference (P < 0.05). Considering the disease control rate and the tolerance of patients with advanced NSCLC, pemetrexed is strongly recommended to be used in clinical.

Critical appraisal of pemetrexed in the treatment of NSCLC and metastatic pulmonary nodules

Pemetrexed, a new multitarget antifolate antineoplastic agent, has significantly improved the overall survival in nonsquamous non-small-cell lung cancer patients. Presently, pemetrexed is recommended for first line treatment in combination with platinum derivatives, for second line treatment as a single agent and, more recently, as maintenance treatment after first line chemotherapy. In this article we critically appraise the status of pemetrexed including pharmacodynamics, pharmacokinetics, toxicity, and the cost effectiveness of pemetrexed, as well as the predictive biomarkers for pemetrexed based chemotherapy.