Practice Patterns and Outcomes for Pemetrexed Plus Platinum Doublet as Neoadjuvant Chemotherapy in Adenocarcinomas of Lung: Looking Beyond the Usual Paradigm. Issue 1 (January 2018)

• Record Type: Journal Article
• Authors: Noronha, V.; Zanwar, S.; Joshi, A.; Patil, V.M.; Mahajan, A.; Janu, A.; Agarwal, J.P.; Bhargava, P.; Kapoor, A.; Prabhash, K.
• Is Part Of: Clinical oncology. Volume 30:Issue 1(2018)
• Page Start: 23
• Page End: 29
• Publication Date: 2018-01
• Subjects: Non-metastatic adenocarcinoma lung -- pemetrexed neoadjuvant chemotherapy; Oncology -- Periodicals; Tumors -- Periodicals; Cancer -- Treatment -- Periodicals; Radiotherapy -- Periodicals; Neoplasms -- Periodicals; Cancer -- Radiotherapy; Cancer -- Treatment; Oncology; Medical radiology; Radiotherapy; Tumors; Electronic journals; Periodicals; 616.994
• DOI: 10.1016/j.clon.2017.11.001
• Languages: English
• ISSNs: 0936-6555

Abstract

Abstract: Aims: Neoadjuvant chemotherapy (NACT) is the standard of care in non-small cell lung cancers (NSCLC) with locally advanced N2 disease. There is a scarcity of data for the pemetrexed–platinum regimen as NACT. Also, apart from N2 disease, the role of NACT in locally advanced NSCLCs for tumour downstaging is unclear. Materials and methods: Non-metastatic adenocarcinomas of lung treated with pemetrexed–platinum-based NACT were analysed. The patients with locoregionally advanced N2 disease and those who were borderline candidates for upfront definitive treatment were planned for NACT after discussion in a multidisciplinary clinic. In total, four cycles of 3-weekly pemetrexed and platinum were delivered in the combined neoadjuvant and adjuvant setting. A response assessment was carried out using RECIST criteria. Progression-free (PFS) and overall survival were calculated using the Kaplan–Meier method. Results: Of 114 patients, 96 evaluable patients received NACT with pemetrexed–platinum. The most common indication for NACT was N2 disease at baseline (46.8%). The objective response rate was 36.4% (95% confidence interval 22–52%), including two complete and 32 partial responses, whereas 12.5% of patients had progressive disease on NACT. The median PFS was 14 months (95% confidence interval 10.7–17.3) and the median overall survival was 22 months (95% confidence interval 15.6–28.4) at a median follow-up of 16 months. There was a significant improvement in the overall survival of patients undergoing definitive therapy versus no definitive therapy (median overall survival 25 months [95% confidence interval 19.6–30.4] versus 12 months [95% confidence interval 3.2–20.7], respectively; P = 0.015, hazard ratio 0.56 [95% confidence interval 0.3–0.9]). Among patients who could not undergo definitive chemoradiation upfront due to dosimetric constraints ( n = 34), 24 (70.6%) patients finally underwent definitive therapy after NACT. Conclusions: Pemetrexed–platinum-based NACT seems to be an effective option and many borderline cases, where upfront definitive therapy is not feasible, may become amenable to the same after incorporation of NACT. Highlights: Provides important insight into the practice patterns for use of neoadjuvant chemotherapy (NACT) in locally advanced lung tumours. Pemetrexed–platinum-based NACT seems to be an efficacious option in non-metastatic adenocarcinomas of lung. Many borderline cases where upfront definitive therapy is not feasible may become amenable to the same after incorporation of NACT.