title: Pemetrexed for the treatment of non-small cell lung cancer.
abstract: BACKGROUND
  Non-small cell lung cancer (NSCLC) is a major cause of cancer-related death worldwide. Although advanced NSCLC is still incurable, various anti-neoplastic agents have become available for the treatment of this disease. Pemetrexed , a multi-target folate antagonist, has improved the survival of non-squamous NSCLC patients. Currently, pemetrexed is approved for first-line treatment in combination with a platinum derivate, for second-line treatment as a single agent and, more recently, as maintenance treatment after first-line chemotherapy.
  
  
  METHODS
  The authors analyzed the state of the art of pemetrexed through a review of the literature. Clinical trials and meta-analyses involving pemetrexed in NSCLC were evaluated. Pemetrexed improved survival of non-squamous NSCLC in first-line, maintenance, and second-line treatments; this benefit is limited to non-squamous histology. Because pemetrexed has become part of the standard of care, current clinical trials are designed to compare it to other investigational combinations. Limited data on resectable disease are available, and additional clinical trials are being conducted.
  
  
  CONCLUSIONS
  Pemetrexed has shown effectiveness and a favorable toxicity profile. Histology-driven indications and the relationship of pemetrexed with thymidylate synthase expression suggest that a more precise definition of predictive biomarkers could be further investigated.
authors.affiliation: IRCCS AOU San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Lung Cancer Unit, Genova, Italy. francesco.grossi@istge.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Genova
authors.forename: Erika
authors.initials: E
authors.lastname: Rijavec
authors.forename: Anna
authors.initials: A
authors.lastname: Truini
authors.forename: Simona
authors.initials: S
authors.lastname: Coco
authors.forename: Claudio
authors.initials: C
authors.lastname: Sini
authors.forename: Giulia
authors.initials: G
authors.lastname: Barletta
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Dal Bello
authors.forename: Angela
authors.initials: A
authors.lastname: Alama
authors.forename: Grazia
authors.initials: G
authors.lastname: Savarino
authors.forename: Paolo
authors.initials: P
authors.lastname: Pronzato
authors.forename: Francesco
authors.initials: F
authors.lastname: Boccardo
authors.forename: Francesco
authors.initials: F
authors.lastname: Grossi
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D005971:Glutamates / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D006147:Guanine / Q000031:analogs & derivatives* / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D000068437:Pemetrexed
chemical_list: D000970:Antineoplastic Agents; D005971:Glutamates; D000068437:Pemetrexed; D006147:Guanine