title: The optimal duration of vitamin supplementation prior to the first dose of pemetrexed in patients with non-small-cell lung cancer.
abstract: Although folic acid and vitamin B12 supplements are recommended during pemetrexed therapy, the optimal duration for supplementation prior to the first dose of pemetrexed has not been defined. We analyzed adverse events during the first cycle of pemetrexed therapy in 350 patients with advanced non-small-cell lung cancer (NSCLC) who had received pemetrexed monotherapy. Patients were divided into two groups: group A and group B included patients who started vitamin supplements 5-14 days versus within 4 days before the first dose of pemetrexed, respectively. Groups A and B included 294 (84.0%) and 56 (16.0%) patients, respectively. The median number of cycles of pemetrexed was three in both groups. Patients in group A and B showed similar rates of leukopenia (6.1% vs. 5.4%, respectively, P = 1.00), neutropenia (5.1% vs. 3.6%, P = 1.00), thrombocytopenia (3.1% vs. 7.1%, P = 0.14), neutropenic fever (0.7% vs. 0%, P = 1.00), fatigue (20.1% vs. 19.6%, P = 0.94), and anorexia (15.0% vs. 21.4%, P = 0.23) during the first cycle of pemetrexed therapy. There were no significant differences in terms of hospitalization (4.4% vs. 5.4%, P = 0.73) or unscheduled visits due to pemetrexed-related adverse events (8.2% vs. 12.5%, P = 0.31) between groups A and B, respectively. Multivariate logistic regression analysis demonstrated that an age of ≥ 65 years (odds ratio, 3.49; 95% CI 1.12-10.86) and poor performance status (odds ratio, 3.96; 95% CI 1.12-14.03) were statistically significant predictive factors for grade 3 or 4 hematologic toxicity. The duration of vitamin supplementation before the first dose of pemetrexed did not affect the development of pemetrexed-related toxicities, suggesting that the initiation of pemetrexed-based chemotherapy does not have to be delayed to accommodate a vitamin supplementation schedule.
authors.affiliation: Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Young Saing
authors.initials: YS
authors.lastname: Kim
authors.forename: Jong-Mu
authors.initials: JM
authors.lastname: Sun
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Ahn
authors.forename: Myung-Ju
authors.initials: MJ
authors.lastname: Ahn
authors.forename: Keunchil
authors.initials: K
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D019587:Dietary Supplements; D005260:Female; D005971:Glutamates / Q000009:adverse effects* / Q000627:therapeutic use*; D006147:Guanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D000068437:Pemetrexed; D012189:Retrospective Studies; D014815:Vitamins / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D005971:Glutamates; D014815:Vitamins; D000068437:Pemetrexed; D006147:Guanine
keywords: Folic acid; Non-small-cell lung cancer; Pemetrexed; Toxicity; Vitamin B12; Vitamin supplementation