title: Systematic review of efficacy and safety of pemetrexed in non-small-cell-lung cancer.
abstract: BACKGROUND
  Lung cancer accounts for 20 % of cancer deaths in Spain. The most frequent subtype (87 %) is non-small cell lung cancer (NSCLC). Pemetrexed is a recently marketed drug added to NSCLC therapeutic arsenal. It seems to have become one of the most used options for the treatment of this condition over the last 3 years.
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of pemetrexed in NSCLC, in the different therapy lines. Method A systematic search of published literature was conducted using the main databases (MEDLINE, EMBASE, the Cochrane Library and the Center for Reviews and Dissemination) and subsequently a search of referenced literature was performed. We included clinical trials, meta-analyses and systematic reviews. The evaluation of the quality of the articles was performed by pairs using specific assessment scales, Critical Appraisal Skills Program (CASP) adapted for CASP Spain. Then we extracted data on efficacy and safety according to the treatment line assessed.
  
  
  RESULTS
  We identified 277 references. Finally, nine clinical trials and a meta-analysis complied with inclusion criteria. In first-line induction, treatment with pemetrexed associated with a platinum was similar in terms of efficacy to other alternative chemotherapy regimens, except in patients with non-squamous histology, in whom survival was higher in the experimental group. In maintenance treatment, greater efficacy was seen with pemetrexed in patients with non-squamous histology. In second-line treatment, there were no significant differences in terms of efficacy and safety for pemetrexed treatment versus other chemotherapy options. The most frequent adverse reactions were: hematological, gastrointestinal and neurological. All were significantly less frequent with pemetrexed versus other alternative therapies, except for liver toxicity.
  
  
  CONCLUSIONS
  Due to the high degree of uncertainty as to its efficacy in certain subgroups of patients, including conflicting data; to its recent incorporation, and therefore lack of safety data in the medium and long term, and the high budgetary impact of its incorporation into health systems, it seems reasonable to optimize its use, identifying those patients who may benefit most.
authors.affiliation: Pharmacy Department, Hospital Universitario Virgen Del Rocío, Manuel Siurot s/n., 41013, Seville, Spain, sg_pm_mary@hotmail.com.
authors.forename: Maria Antonia
authors.initials: MA
authors.lastname: Pérez-Moreno
authors.forename: Mercedes
authors.initials: M
authors.lastname: Galván-Banqueri
authors.forename: Sandra
authors.initials: S
authors.lastname: Flores-Moreno
authors.forename: Angela
authors.initials: A
authors.lastname: Villalba-Moreno
authors.forename: Jesús
authors.initials: J
authors.lastname: Cotrina-Luque
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Bautista-Paloma
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D005971:Glutamates / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006147:Guanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D000068437:Pemetrexed; D016032:Randomized Controlled Trials as Topic; D013030:Spain
chemical_list: D000970:Antineoplastic Agents; D005971:Glutamates; D000068437:Pemetrexed; D006147:Guanine