title: Chemotherapy in Metastatic NSCLC - New Regimens (Pemetrexed, Nab-Paclitaxel).
abstract: Platinum-based chemotherapy doublets have been the standard approach to first-line therapy for more than a decade. Many randomized trials testing new combinations have not been able to produce significant gains in patient outcomes when these studies have looked at an unselected patient population. The recognition of the biologic importance of histology and molecular features of lung cancer has dramatically impacted on patient care, as can be easily recognized by the advent of targeted therapy for molecularly defined lung cancers. Similarly, for lung cancers without recognized driver mutations, subgroup evaluations of trials-based histology has identified that some chemotherapy regimens offer greater benefit in the squamous cell or the non-squamous cell groups. Two such examples are nab-paclitaxel and pemetrexed. These have shown improved anti-tumor activity and a decreased toxicity profile compared to standard combinations. Preferential activity in histologic divided patient subgroups can allow the clinician to personalize his approach to care. The role of these two agents in the management of NSCLC will be described in this article.
authors.affiliation: Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame , Montreal, QC , Canada.
authors.forename: Normand
authors.initials: N
authors.lastname: Blais
authors.affiliation: McGill University Health Centre (MUHC), Royal Victoria Hospital , Montreal, QC , Canada.
authors.forename: Vera
authors.initials: V
authors.lastname: Hirsh
keywords: clinical trials; histology; metastatic; nab-paclitaxel; non-small cell lung carcinoma; pemetrexed; solvent-based paclitaxel
references.citation: J Clin Oncol. 2009 Dec 20;27(36):6251-66
references.pmid: 19917871
references.citation: Clin Cancer Res. 2006 Feb 15;12(4):1317-24
references.pmid: 16489089
references.citation: Ann Oncol. 2013 Feb;24(2):314-321
references.pmid: 23123509
references.citation: J Clin Oncol. 2001 Jul 1;19(13):3210-8
references.pmid: 11432888
references.citation: J Thorac Oncol. 2008 Jan;3(1):13-7
references.pmid: 18166835
references.citation: J Clin Oncol. 2013 Dec 1;31(34):4349-57
references.pmid: 24145346
references.citation: J Clin Oncol. 2003 Nov 1;21(21):3909-17
references.pmid: 14581415
references.citation: J Clin Oncol. 2000 Oct 1;18(19):3390-9
references.pmid: 11013280
references.citation: Biochem Pharmacol. 2003 Aug 1;66(3):431-8
references.pmid: 12907242
references.citation: J Clin Oncol. 2013 Aug 20;31(24):3004-11
references.pmid: 23835708
references.citation: J Clin Oncol. 2010 Apr 10;28(11):1835-42
references.pmid: 20212250
references.citation: Eur J Cancer. 2001 Sep;37(13):1590-8
references.pmid: 11527683
references.citation: N Engl J Med. 2004 May 20;350(21):2129-39
references.pmid: 15118073
references.citation: Lancet. 2009 May 2;373(9674):1525-31
references.pmid: 19410716
references.citation: J Clin Oncol. 2010 Feb 20;28(6):911-7
references.pmid: 20100966
references.citation: J Clin Oncol. 2009 Jul 1;27(19):3217-24
references.pmid: 19433683
references.citation: J Clin Oncol. 2013 Aug 10;31(23):2895-902
references.pmid: 23835707
references.citation: N Engl J Med. 2002 Jan 10;346(2):92-8
references.pmid: 11784875
references.citation: Cancer Chemother Pharmacol. 1999;44(5):372-80
references.pmid: 10501910
references.citation: J Natl Compr Canc Netw. 2013 Jun 1;11(6):645-53; quiz 653
references.pmid: 23744864
references.citation: Proc Natl Acad Sci U S A. 2004 Sep 7;101(36):13306-11
references.pmid: 15329413
references.citation: J Clin Oncol. 2003 Aug 15;21(16):3016-24
references.pmid: 12837811
references.citation: J Thorac Oncol. 2014 Jan;9(1):83-90
references.pmid: 24346096
references.citation: Ann Oncol. 2013 Sep;24(9):2390-6
references.pmid: 23842283
references.citation: J Clin Oncol. 2012 Jun 10;30(17):2055-62
references.pmid: 22547591
references.citation: J Clin Oncol. 2008 Jul 20;26(21):3543-51
references.pmid: 18506025
references.citation: Cancer. 2014 May 1;120(9):1379-86
references.pmid: 24481719
references.citation: J Clin Oncol. 2000 Feb;18(3):623-31
references.pmid: 10653877
references.citation: J Clin Oncol. 2005 Feb 1;23(4):857-65
references.pmid: 15681531
references.citation: J Clin Oncol. 2002 Nov 1;20(21):4285-91
references.pmid: 12409326
references.citation: Nature. 2007 Aug 2;448(7153):561-6
references.pmid: 17625570
references.citation: Clin Pharmacokinet. 2003;42(7):665-85
references.pmid: 12844327
references.citation: Cancer. 2006 Oct 1;107(7):1589-96
references.pmid: 16955506
references.citation: J Clin Oncol. 2003 Apr 15;21(8):1556-61
references.pmid: 12697881
references.citation: N Engl J Med. 2008 Sep 25;359(13):1367-80
references.pmid: 18815398
references.citation: Lancet. 2009 Oct 24;374(9699):1432-40
references.pmid: 19767093
references.citation: Ann Oncol. 2009 Jul;20(7):1249-56
references.pmid: 19276396
references.citation: Nature. 2012 Sep 27;489(7417):519-25
references.pmid: 22960745
references.citation: Clin Cancer Res. 2008 Oct 15;14(20):6618-24
references.pmid: 18927303
references.citation: Clin Cancer Res. 2012 Feb 15;18(4):1167-76
references.pmid: 22228640
references.citation: J Clin Oncol. 2006 Apr 1;24(10):1633-42
references.pmid: 16575015
references.citation: J Clin Oncol. 1990 Jul;8(7):1263-8
references.pmid: 1972736
references.citation: J Clin Oncol. 2004 May 1;22(9):1589-97
references.pmid: 15117980
references.citation: J Thorac Oncol. 2011 Jan;6(1):64-70
references.pmid: 21119545