Pemetrexed versus gefitinib versus erlotinib in previously treated non-small cell lung cancer by retrospective analysis

e19103

Background: The standards in 2nd-line therapy with advanced non-small cell lung cancer (NSCLC) were erlotinib or pemetrexed as well as docetaxel. To evaluate the efficacies and safeties of pemetrexed, gefitinib, and erlotinib in previously treated NSCLC we analyzed the datas retrospectively. Methods: Eligible patents were 1) histologically confirmed pretreated advanced (stage IIIB or IV) NSCLC, 2) with at least one measurable lesion, 3) age over 18 years, 4) performance status (PS) 0–2, and 5) should never experience other two drugs as previous therapy. Patients of pemetrexed group received IV infusion of 500mg/m2 pemetrexed mixed with normal saline every 3 weeks with vitamin B12 and folate supplementation. Patients of gefitinib group received gefitinib 250mg PO daily and of erlotinib took erlotinib 150mg PO daily. Cycles of IV pemetrexed or taking PO drugs were continued until disease progression or unacceptable toxicity. Results: we analyzed 57 patients (pemetrexed; 20, gefitnib; 20, and erlotinib; 17). The response rates were 5.3%, 25.0%, and 12.5% (P=0.22), and the disease control rate were 5.3%, 40.0%, and 50.0% respectively (P<0.01). Median progression-free survival (PFS) of pemetrexed, gefitinib, and erlotinib were 1.7, 3.5 and 4.4 months (P<0.01) and median overall survival (OS) were 5.6, 21.8 and 21.5 months respectively (P=0.04). In subgroup analysis, patients with non-squamous carcinoma, smokers and good PS (0 or 1) showed longer PFS and OS in gefitinib and erlotinib compared with in pemetrexed. All of these agents showed mild and tolerable toxicity. Conclusions: In retrospective analysis, the patients with gefitinib or erlotinib had longer PFS and OS than pemetrexed, eventhough there was no significant difference for response rate in three group. These results have to confirm by large randomized prospective study because the sample size was small and it was not randomized.

No significant financial relationships to disclose.

Evidence for the in vivo generation of oxidatively modified epitopes in patients with atherosclerotic endothelium

There is increasing evidence that autoantibodies (AAbs) against oxidatively modified low-density lipoprotein (LDL) are present in humans and may be detected in fasting plasma. Using a standardized immunoassay for the detection of circulating levels of AAbs against malondialdehyde (MDA)-modified LDL, we examined the acute changes in AAb levels during postprandial lipemia in a group of men and women without (n = 28) and with (n = 17) normal endothelium. The presence of atherosclerotic vessel is documented by clinical evidence of coronary artery disease (CAD). In response to the oxidative stress associated with postprandial lipemia, statistically significant reductions in AAb levels were demonstrated at 2 and 4 hours postprandially by paired t test. In patients with atherosclerotic arterial wall, the mean AAb level was reduced to 90.8% of fasting levels (P < .001) after 2 hours and to 90% after 4 hours (P < .01). This acute reduction in AAbs against MDA-LDL appears to be unique to atherosclerotic patients and could not be demonstrated in young controls with healthy blood vessels. In nonatherosclerotic controls, the mean normalized levels during postprandial lipemia were not statistically different from baseline (104.5% at 2 hours and 104.6% at 4 hours). The transient reduction in AAb levels with postprandial lipemia in atherosclerotic patients could be reproduced in a subset of the CAD patients after significant improvement in the lipid profile with weight loss. In patients with atherosclerotic disease, the transient reduction in the level of circulating AAbs reflects either an increased propensity to generate oxidatively modified epitopes or a reduced capacity to remove excess modified epitopes. These data are the first in vivo demonstration of an acute change in the oxidative process during postprandial lipemia.