Pemetrexed and gemcitabine versus carboplatin and gemcitabine in non-small cell lung cancer: a randomized noninferiority phase II study in one center.
BACKGROUND
The standard treatment for non-small cell lung cancer (NSCLC) stages IIIb and IV is a platinum compound combined with a third-generation cytotoxic agent. We decided to conduct a phase II study to assess whether the platinum compound could be replaced with pemetrexed with similar results and without an increase in side effects.


METHODS
Consecutive eligible patients were randomized to either the standard arm of gemcitabine plus carboplatin (GC) or the experimental arm of gemcitabine plus pemetrexed (GP).


RESULTS
Fifty evaluable patients were enrolled in the GC arm, and 44 received GP. There were 10 partial responses in the GC arm and 16 in the GP arm. With GC, mean survival was 9 months compared with 15 months with GP. The side effects were similar in both groups.


CONCLUSIONS
Pemetrexed can replace platinum compounds in the first-line treatment of stage IIIb and IV NSCLC without increasing the side effects. A trend toward better survival was observed in the patients receiving pemetrexed instead of a platinum compound, and this should be studied further.
Karolinska Hospital, Stockholm, Sweden.
Eva
E
Branden
Karolinska Hospital, Stockholm, Sweden gunnar.hillerdal@karolinska.se.
Gunnar
G
Hillerdal
Karolinska Hospital, Stockholm, Sweden.
Karl
K
Kolbeck
Karolinska Hospital, Stockholm, Sweden.
Hirsh
H
Koyi
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D000068437:Pemetrexed / Q000008:administration & dosage; D016896:Treatment Outcome; D000093542:Gemcitabine
D000068437:Pemetrexed; D003841:Deoxycytidine; D016190:Carboplatin; D000093542:Gemcitabine