Pemetrexed in second-line treatment of non-small-cell lung cancer.
According to the updated 2004 guidelines of the American Society of Clinical Oncology (ASCO) on the treatment of advanced non-small-cell lung cancer (NSCLC), docetaxel (Taxotere) can be considered the standard second-line chemotherapy in patients relapsing after frontline therapy. This was based on two phase III trials (TAX 317 and TAX 320) that demonstrated the superiority of docetaxel at 75 mg/m2 in the parameters of survival, quality of life, and disease/symptom control when compared to best supportive care or alternative single-agent chemotherapy. The response rate was approximately 60%, with a median survival time of 7 months and a 1-year survival rate of 30%. Despite the activity demonstrated, this schedule showed an important toxicity profile, with grade 3/4 neutropenia and febrile neutropenia occurring in 70% and 11% of patients, respectively. However, the results obtained by these studies stimulated research interest in new drugs for this disease setting. Pemetrexed (Alimta), a new multitargeted antifolate, has achieved promising results in NSCLC treatment, as a single agent or in combination with other drugs. In the second-line setting, a large phase II study demonstrated good activity of pemetrexed, with an acceptable toxicity profile. This led to a phase III registration trial that compared pemetrexed at 500 mg/m2 to the standard docetaxel dose of 75 mg/m2. While results from this trial demonstrated a similar efficacy of the two regimens in response rate and survival, pemetrexed achieved a better safety profile. These results support the use of pemetrexed as a new option in the second-line treatment of NSCLC.
De Marinis
Filippo
F
Pulmonary-Oncology Unit, Department of Lung Diseases, Forlanini Hospital, Rome, Italy. f.demarinis@oncpneumo.it
De Petris
Luigi
L
D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D017326:Clinical Trials, Phase III as Topic; D000077143:Docetaxel; D005493:Folic Acid Antagonists / Q000008:administration & dosage*; D005971:Glutamates / Q000008:administration & dosage*; D006147:Guanine / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D000068437:Pemetrexed; D016879:Salvage Therapy; D043823:Taxoids / Q000008:administration & dosage; D013940:Thymidylate Synthase / Q000037:antagonists & inhibitors*
D000970:Antineoplastic Agents; D005493:Folic Acid Antagonists; D005971:Glutamates; D043823:Taxoids; D000068437:Pemetrexed; D000077143:Docetaxel; D006147:Guanine; D013940:Thymidylate Synthase