title: Phase II study of perioperative chemotherapy with cisplatin and pemetrexed in non-small-cell lung cancer.
abstract: BACKGROUND
  Pathologic complete response (pCR) with neoadjuvant chemotherapy is associated with improved survival in many solid tumors. We evaluated pCR rate of cisplatin with pemetrexed in non-small-cell lung cancer.
  
  
  METHODS
  Patients with stages IB to IIIA non-small-cell lung cancer, Eastern Cooperative Oncology Group performance status 0 to 1 were enrolled in this single-arm phase II trial using two-stage design with 90% power to detect pCR rate of more than or equal to 10%. Pretreatment mediastinal lymph node biopsy was required. Patients received three cycles of cisplatin 75 mg/m with pemetrexed 500 mg/m (day 1 every 21 days) preoperatively and additional two cycles within 60 to 80 days after surgery. The primary end point was pCR. Polymorphisms in FPGS, GGH, SLC19A1, and TYMS genes were correlated with treatment outcomes.
  
  
  RESULTS
  Thirty-eight patients were enrolled, with median age of 62.5 years. Preoperatively, 26% had squamous histology, and 34% had biopsy-proven N2 involvement. R0 resection was achieved in 94% of the 34 patients who underwent surgery, and 54% had documented N2 clearance. There was no pCR seen. Median disease-free survival (DFS) and overall survival of these patients have not yet been reached in contrast to median of 13.8 and 24.2 months, respectively, in patients with persistent N2 disease (p = 0.3241 and p = 0.1022, respectively). There was a statistically significant association between DFS and postoperative tumor, node, metastasis stage (p = 0.0429), SLC19A1 rs3788189 TT genotype (p = 0.0821), and viable tumor defined as less than or equal to 10% of resected specimen (p = 0.026).
  
  
  CONCLUSIONS
  The primary end point was not met. Patients with N2 clearance, less than or equal to 10% viable tumor in the resected specimen, and SLC19A1 rs3788189 TT genotype have favorable DFS outcomes.
authors.affiliation: *Roswell Park Cancer Institute, Buffalo, New York; †The Oncology Institute of Hope and Innovation, Anaheim, California; ‡Rochester General Hospital, Rochester, New York; and §Department of Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Grace K
authors.initials: GK
authors.lastname: Dy
authors.forename: Paul N
authors.initials: PN
authors.lastname: Bogner
authors.forename: Wei
authors.initials: W
authors.lastname: Tan
authors.forename: Todd L
authors.initials: TL
authors.lastname: Demmy
authors.forename: Aamer
authors.initials: A
authors.lastname: Farooq
authors.forename: Hongbin
authors.initials: H
authors.lastname: Chen
authors.forename: Saikrishna S
authors.initials: SS
authors.lastname: Yendamuri
authors.forename: Chukwumere E
authors.initials: CE
authors.lastname: Nwogu
authors.forename: Peter W
authors.initials: PW
authors.lastname: Bushunow
authors.forename: James
authors.initials: J
authors.lastname: Gannon
authors.forename: Araba A
authors.initials: AA
authors.lastname: Adjei
authors.forename: Alex A
authors.initials: AA
authors.lastname: Adjei
authors.forename: Nithya
authors.initials: N
authors.lastname: Ramnath
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000556:secondary; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018287:Carcinoma, Large Cell / Q000188:drug therapy / Q000401:mortality / Q000556:secondary; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000556:secondary; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005971:Glutamates / Q000008:administration & dosage; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D000068437:Pemetrexed; D019990:Perioperative Care; D011379:Prognosis; D012074:Remission Induction; D015996:Survival Rate
chemical_list: D005971:Glutamates; D000068437:Pemetrexed; D006147:Guanine; D002945:Cisplatin