Pemetrexed single agent chemotherapy in previously treated patients with locally advanced or metastatic non-small cell lung cancer

Francesca Russo, Alessandra Bearz, Gianni Pampaloni, Investigators of Italian Pemetrexed Monotherapy of NSCLC Group, Umberto Tirelli, Roberto Bordonaro, Claudio Verusio, Alberto Rosa Bian, Maurizio Marangolo, Angelo Raffaele Bianco, Francesco Grossi, Angelo Gambi, Guido Francini, Giorgio Sogno, Paolo Manente, Nicola Gebbia, Fabrizio Artioli, Alessandro Masotti, Ernesto Pozzi, Salvatore Tumolo, Rodolfo Passalacqua, Clelia Casartelli, Franco Montanari, Giuseppe Colucci, Santi Barbera, Sergio Ricci, Lucio Trodella, Vincenzo Valentini, Giovanni Mantovani, Alberto Ravaioli, Silvio Monfardini, Sandro Barni, Raffaella Felletti, Franco Testore, Antonio Ardizzoia, Roberto Bollina, Giorgio Cruciani, Enzo Pasquini, Francesca Russo, Alessandra Bearz, Gianni Pampaloni, Investigators of Italian Pemetrexed Monotherapy of NSCLC Group, Umberto Tirelli, Roberto Bordonaro, Claudio Verusio, Alberto Rosa Bian, Maurizio Marangolo, Angelo Raffaele Bianco, Francesco Grossi, Angelo Gambi, Guido Francini, Giorgio Sogno, Paolo Manente, Nicola Gebbia, Fabrizio Artioli, Alessandro Masotti, Ernesto Pozzi, Salvatore Tumolo, Rodolfo Passalacqua, Clelia Casartelli, Franco Montanari, Giuseppe Colucci, Santi Barbera, Sergio Ricci, Lucio Trodella, Vincenzo Valentini, Giovanni Mantovani, Alberto Ravaioli, Silvio Monfardini, Sandro Barni, Raffaella Felletti, Franco Testore, Antonio Ardizzoia, Roberto Bollina, Giorgio Cruciani, Enzo Pasquini

Abstract

Background: The main objective of this study was to evaluate the safety of second-line pemetrexed in Stage IIIB or IV NSCLC.

Methods: Overall, 95 patients received pemetrexed 500 mg/m2 i.v. over Day 1 of a 21-day cycle. Patients also received oral dexamethasone, oral folic acid and i.m. vitamin B12 supplementation to reduce toxicity. NCI CTC 2.0 was used to rate toxicity. All the adverse events were graded in terms of severity and relation to study treatment. Dose was reduced in case of toxicity and treatment was delayed for up to 42 days from Day 1 of any cycle to allow recovering from study drug-related toxicities. Tumor response was measured using the RECIST criteria.

Results: Patients received a median number of 4 cycles and 97.8% of the planned dose. Overall, 75 patients (78.9% of treated) reported at least one adverse event: 34 (35.8%) had grade 3 as worst grade and only 5 (5.2%) had grade 4. Drug-related events occurred in 57.9% of patients. Neutropenia (8.4%) and leukopenia (6.3 %) were the most common grade 3/4 hematological toxicities. Grade 3 anemia and thrombocytopenia were reported in 3.2% and 2.1% of patients, respectively. Diarrhea (6.3%), fatigue (3.2%) and dyspnea (3.2%) were the most common grade 3/4 non-hematological toxicities. The most common drug-related toxicities (any grade) were pyrexia (11.6%), vomiting, nausea, diarrhea and asthenia (9.5%) and fatigue (8.4%). Tumor Response Rate (CR/PR) in treated patients was 9.2%. The survival at 4.5 months (median follow-up) was 79% and the median PFS was 3.1 months. Twenty patients (21.1%) died mainly because of disease progression.

Conclusion: Patients with locally advanced or metastatic NSCLC could benefit from second-line pemetrexed, with a low incidence of hematological and non-hematological toxicities.

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