title: Randomized Phase II Study of Pemetrexed Versus Gefitinib in Previously Treated Patients with Advanced Non-small Cell Lung Cancer.
abstract: OBJECTIVE
  This study aimed to evaluate the efficacy and safety of pemetrexed versus gefitinib in patients with advanced non-small cell lung cancer (NSCLC) previously treated with chemotherapy.
  
  
  METHODS
  Patients with advanced (stage IIIB or IV) or recurrent NSCLC were randomly assigned to receive either 500 mg/m² of pemetrexed intravenously every 3 weeks or gefitinib 250 mg/day orally. The primary end point was progression-free survival (PFS) at 6 months.
  
  
  RESULTS
  A total of 95 patients were enrolled (47 for pemetrexed and 48 for gefitinib). Most patients were male (72%) and current/ex-smokers (69%), and 80% had non-squamous cell carcinoma. The epidermal growth factor receptor (EGFR) mutation status was determined in 38 patients (40%); one patient per each arm was positive for EGFR mutation. The 6-month PFS rates were 22% and 15% for pemetrexed and gefitinib, respectively (p=0.35). Both arms showed an identical median PFS of 2.0 months and a median overall survival (OS) of 8.5 months. In EGFR wild-type patients, higher response rate (RR) and longer PFS as well as OS were achieved via pemetrexed compared with gefitinib, although there were no significant differences (RR: 39% vs. 9%, p=0.07; median PFS: 6.6 months vs. 3.1 months, p=0.45; median OS: 29.6 months vs. 12.9 months, p=0.62). Toxicities were mild in both treatment arms. Frequently reported toxicities were anemia and fatigue for pemetrexed, and skin rash and anorexia for gefitinib.
  
  
  CONCLUSIONS
  Both pemetrexed and gefitinib had similar efficacy with good tolerability as second-line treatment in unselected patients with advanced NSCLC. However, pemetrexed is considered more effective than gefitinib for EGFR wild-type patients.
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Young Saing
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Cho
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Hyun Sun
authors.initials: HS
authors.lastname: Woo
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Junshik
authors.initials: J
authors.lastname: Hong
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Hee Kyung
authors.initials: HK
authors.lastname: Ahn
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Inkeun
authors.initials: I
authors.lastname: Park
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Sun Jin
authors.initials: SJ
authors.lastname: Sym
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Kyung
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Shin Myung
authors.initials: SM
authors.lastname: Kang
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Jeong-Woong
authors.initials: JW
authors.lastname: Park
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Sung Hwan
authors.initials: SH
authors.lastname: Jeong
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Jinny
authors.initials: J
authors.lastname: Park
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Dong Bok
authors.initials: DB
authors.lastname: Shin
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D009364:Neoplasm Recurrence, Local; D000068437:Pemetrexed / Q000627:therapeutic use*; D011799:Quinazolines / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D000068437:Pemetrexed; D000077156:Gefitinib
keywords: Epidermal growth factor receptor; Gefitinib; Non-small cell lung cancer; Pemetrexed; Second-line