A randomized phase II study of bortezomib and pemetrexed, in combination or alone, in patients with previously treated advanced non-small-cell lung cancer.
BACKGROUND
This is a phase II randomized study to evaluate the efficacy and safety of bortezomib and pemetrexed alone or in combination, in patients with previously treated advanced non-small-cell lung cancer (NSCLC). The primary end point was assessment of response rate.


METHODS
A total of 155 patients were randomized (1:1:1) to pemetrexed (500mg/m(2)) on day 1 plus bortezomib (1.6mg/m(2)) on days 1 and 8 (Arm A) or pemetrexed (500mg/m(2)) on day 1 (Arm B) or bortezomib (1.6mg/m(2)) on days 1 and 8 (Arm C) of a 21 day cycle. Response rate was assessed by investigators using Response Evaluation Criteria In Solid Tumors (RECIST) criteria and toxicity assessed by the National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE) grading system.


RESULTS
Response rate was 7% in Arm A, 4% in Arm B, and 0% in Arm C; disease control rates were 73%, 62%, and 43%, respectively. Median overall survival was 8.6 months in Arm A, 12.7 months in Arm B, and 7.8 months in Arm C; time to progression was 4.0 months, 2.9 months, and 1.4 months, respectively. Most common reported adverse events >/=grade 3 were neutropenia (19%), thrombocytopenia (15%), and dyspnea (13%) in Arm A, neutropenia (10%) in Arm B, and dyspnea (13%) and fatigue (10%) in Arm C.


CONCLUSIONS
In previously treated NSCLC the addition of bortezomib to pemetrexed was well tolerated but offered no statistically significant response or survival advantage versus pemetrexed alone, while bortezomib alone showed no clinically significant activity.
Scagliotti
Giorgio V
GV
University of Torino, Department of Clinical & Biological Sciences, Thoracic Oncology Unit, S. Luigi Hospital, Regione Gonzole 10, Orbassano (Torino) 10043, Italy. giorgio.scagliotti@unito.it
Germonpré
Paul
P
Bosquée
Leon
L
Vansteenkiste
Johan
J
Gervais
R
R
Planchard
David
D
Reck
Martin
M
De Marinis
Filippo
F
Lee
Jin Soo
JS
Park
Keunchil
K
Biesma
Bonne
B
Gans
Steven
S
Ramlau
R
R
Szczesna
Aleusandra
A
Makhson
A
A
Manikhas
G
G
Morgan
Bruno
B
Zhu
Y
Y
Chan
Kai C
KC
von Pawel
Joachim
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001897:Boronic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D000069286:Bortezomib; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004417:Dyspnea / Q000209:etiology; D005260:Female; D005971:Glutamates / Q000008:administration & dosage* / Q000009:adverse effects; D006147:Guanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009503:Neutropenia / Q000209:etiology; D000068437:Pemetrexed; D011719:Pyrazines / Q000008:administration & dosage* / Q000009:adverse effects; D016019:Survival Analysis; D013921:Thrombocytopenia / Q000209:etiology
D001897:Boronic Acids; D005971:Glutamates; D011719:Pyrazines; D000068437:Pemetrexed; D006147:Guanine; D000069286:Bortezomib