title: Third-line or fourth-line chemotherapy in non-small-cell lung cancer patients with relatively good performance status.
abstract: BACKGROUND
  Our aim here was to explore treatment efficacy of pemetrexed and docetaxel in non-small-cell lung cancer patients who had failed previous chemotherapy and epidermal growth factor receptor-tyrosine kinase inhibitor therapy.
  
  
  METHODS
  We retrospectively reviewed clinical data of our non-small-cell lung cancer patients who received third- or fourth-line chemotherapy with pemetrexed or docetaxel in our institution from January 2006 to December 2009.
  
  
  RESULTS
  One hundred and twenty-three patients received treatment, including 85 patients with pemetrexed treatment and 38 patients with docetaxel treatment. There was no difference in tumor response rate and toxicity profiles when using pemetrexed as third- or fourth-line treatment, neither was there difference in docetaxel treatment of third- versus fourth-line treatment. There was also no difference between docetaxel and pemetrexed in response rate and control rate when they were used as fourth-line treatment. However, docetaxel used in fourth-line treatment had higher incidence of neutropenia and more frequent need of granulocyte colony-stimulating factor support compared with pemetrexed in fourth-line treatment. Median progression-free survivals (PFSs) were 2.6 months and 3.8 months when using pemetrexed as third- and fourth-line treatment, respectively (p = 0.417). Median PFSs were 3.8 months and 4.8 months when using docetaxel as third- and fourth-line treatment, respectively (p = 0.882). There was also no difference in PFS between pemetrexed and docetaxel, both in third- and fourth-line treatment. Median survivals were 13.4, 12.2, 13.2, and 13 months for pemetrexed in third-line, fourth-line, and docetaxel in third-line and fourth-line treatment, respectively.
  
  
  CONCLUSIONS
  This retrospective study of pemetrexed and docetaxel showed relatively safe toxicity profile, reasonable response rate, and long survival when used as third- and fourth-line chemotherapy. Thus, it is reasonable to give good performance status patients third- and fourth-line chemotherapy. A phase III randomized trial is needed for better clarification of these issues.
authors.affiliation: Chest Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. ymchen@vghtpe.gov.tw
authors.forename: Yuh-Min
authors.initials: YM
authors.lastname: Chen
authors.forename: Jen-Fu
authors.initials: JF
authors.lastname: Shih
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Fan
authors.forename: Chieh-Hung
authors.initials: CH
authors.lastname: Wu
authors.forename: Kun-Ta
authors.initials: KT
authors.lastname: Chou
authors.forename: Chun-Ming
authors.initials: CM
authors.lastname: Tsai
authors.forename: Yu-Chin
authors.initials: YC
authors.lastname: Lee
authors.forename: Reury-Perng
authors.initials: RP
authors.lastname: Perng
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Whang-Peng
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality; D018572:Disease-Free Survival; D000077143:Docetaxel; D005260:Female; D005971:Glutamates / Q000627:therapeutic use*; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D000068437:Pemetrexed; D012189:Retrospective Studies; D016879:Salvage Therapy; D043823:Taxoids / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D005971:Glutamates; D043823:Taxoids; D000068437:Pemetrexed; D000077143:Docetaxel; D006147:Guanine