Meta-Analysis of First-Line Pemetrexed Plus Platinum Treatment in Compared to Other Platinum-Based Doublet Regimens in Elderly East Asian Patients With Advanced Nonsquamous Non-Small-Cell Lung Cancer
Journal
Clinical Lung Cancer
Journal Volume
17
Journal Issue
5
Pages
e103-e112
Date Issued
2016
Author(s)
Abstract
We performed a meta-analysis with maximum individual patient data from three phase 3 trials with data available for an elderly East Asian population to compare therapy with a pemetrexed plus platinum doublet with other platinum-based doublets as first-line treatment for nonsquamous non–small-cell lung cancer patients. Consistent with all-age East Asians, better tumor response and tolerability supports a preference for pemetrexed/platinum in elderly East Asians. Background Pemetrexed plus platinum has become a standard of care in first-line treatment for patients with advanced nonsquamous non–small-cell lung cancer. However, elderly lung cancer patients are generally understudied and undertreated in clinical practice in East Asia because of safety concerns. This analysis aimed to provide a picture of the clinical benefit of pemetrexed/platinum in the first-line setting for elderly (age ≥ 65 years) East Asian patients. Patients and Methods Individual patient data from 3 randomized controlled phase 3 trials that enrolled East Asian patients were analyzed in this meta-analysis. Results In elderly East Asian patients (63 in the pemetrexed/platinum group and 42 in the control group), pemetrexed/platinum treatment achieved more benefits compared to other platinum-based doublets, including better overall response rate (32.8% vs. 7.5%), favorable progression-free survival (not statistically significant in adjusted hazard ratio), and significantly longer (3.15 vs. 1.54 months) survival without drug-related grade 3/4 toxicity. Overall survival was numerically prolonged (16.33 vs. 13.77 months; not statistically significant). These benefit trends were similar to those in all-age East Asian patients. In elderly East Asians, pemetrexed/platinum treatment was also associated with a lower incidence rate of drug-related grade 3/4 adverse events. The adverse event profile was similar to that in all-age East Asians. There were no unexpected adverse events. Conclusion Pemetrexed/platinum had good efficacy and also resulted in better overall response and tolerability than other platinum-based doublets as first-line treatment in nonsquamous non–small cell lung cancer in elderly East Asians, which was consistent with data observed in all-age East Asians. ? 2016 The Authors
Subjects
IPD; NSCLC; ORR; PFS; SWT
SDGs
Other Subjects
carboplatin; cisplatin; docetaxel; gemcitabine; granulocyte colony stimulating factor; granulocyte macrophage colony stimulating factor; pemetrexed; antineoplastic agent; pemetrexed; platinum derivative; advanced cancer; aged; anemia; anorexia; Article; cancer survival; drug safety; East Asian; fatigue; febrile neutropenia; hazard ratio; human; laboratory test; leukopenia; lymphocytopenia; meta analysis; multiple cycle treatment; neutropenia; non small cell lung cancer; overall survival; phase 3 clinical trial (topic); progression free survival; randomized controlled trial (topic); systematic review; thrombocytopenia; treatment response; vomiting; Asian continental ancestry group; Carcinoma, Non-Small-Cell Lung; comparative study; disease free survival; female; Lung Neoplasms; male; pathology; survival rate; treatment outcome; Aged; Antineoplastic Combined Chemotherapy Protocols; Asian Continental Ancestry Group; Carcinoma, Non-Small-Cell Lung; Clinical Trials, Phase III as Topic; Disease-Free Survival; Female; Humans; Lung Neoplasms; Male; Pemetrexed; Platinum Compounds; Randomized Controlled Trials as Topic; Survival Rate; Treatment Outcome
Publisher
Elsevier Inc.
Type
journal article