Background: It is well known that patients with advanced non-squamous non-small cell lung cancer (NSCLC) benefit substantially from platinum-based chemotherapy containing pemetrexed (pem/platinum ChT). Additionally, maintenance therapy with pemetrexed further improves survival in patients with clinical benefit (CB) to induction Cht. Evidence based data show that using pem instead of gemcitabine and maintenance therapy approach improves survival rates in pts with advanced non-squamous NSCLC to around 13 months (mo). The aim of our observational study was to evaluate the efficacy of first line pem/platinum in advanced non-squamous NSCLC treated in routine clinical practice.
Methods: Consecutive pts, treated with first-line pem/platinum ChT between January 2010 and December 2013 and followed at a single institution were included. Pts with epidermal growth factor receptor (EGFR) mutation-positive disease were not included in the analysis. All data were obtained from our hospital cancer registry. Until the beginning of 2012 the availability of pem was limited due to reimbursement policy and maintenance pem was not yet available.
Results: Overall, 114 pts were included, 31 were treated before and 83 after the year 2012. Median overall survival (mOS) in the whole group was 12.5 mo (95% CI: 10.7-14.2), with impressive 14.3 mo (95% CI: 10.9-17.7) for patients treated before 2012, when availability of pem was limited, and 11.7 mo (95% CI: 9.4-14) (P=0.367) for those treated after 2012. Median number of ChT cycles received before 2012 was 6 (range, 1-6) and after 2012, 4 in induction phase (range, 1-4) and 4 in maintenance phase (range, 1-22). Of note, only 68.4% (39/57) of pts achieving CB (57/80) after 4 cycles of induction pem/platinum Cht continued therapy with pem maintenance and mOS of those pts was 18.9 mo (95% CI: 12.0-21.7), while it was only 11.7 mo (95% CI: 7.7-15.7) for pts who did not receive it (P=0.026).
Conclusions: According to our observations, survival of advanced non-squamous NSCLC pts treated routinely with first-line pem/platinum Cht is highly comparable to the results obtained in randomized clinical trials. In addition, if used, the maintenance pem approach prolongs OS and has to be implemented in the largest possible number of eligible patients.
