title: Renal insufficiency is the leading cause of double maintenance (bevacizumab and pemetrexed) discontinuation for toxicity to advanced non-small cell lung cancer in real world setting.
abstract: OBJECTIVE
  In advanced non-small cell lung cancer (NSCLC), maintenance therapy has emerged as a novel therapeutic reference for patients with non-progressive disease after platinum-based induction chemotherapy. However, the use of double maintenance (DM) with pemetrexed and bevacizumab is still being evaluated in terms of its clinical benefits and safety profile. The objective of this retrospective study was to describe the reasons for DM discontinuation in a real-world setting.
  
  
  METHODS
  Patients with advanced non-squamous NSCLC were eligible if they had received at least 4 cycles of induction chemotherapy, followed by at least 1 cycle of DM. They were identified by using the oncology pharmacy database of 17 French centers.
  
  
  RESULTS
  Eighty-one patients who began a DM after induction chemotherapy were identified from September 2009 to April 2013. Among the 78 patients who had stopped DM at the time of the analysis, the main reasons for discontinuation were disease progression (42%), adverse events (33%), and personal preference (8%). The most frequent toxicity responsible for DM discontinuation was renal insufficiency (54%).
  
  
  CONCLUSIONS
  For patients with advanced NSCLC eligible for DM therapy, a particular attention should be paid to potential renal failure. Kidney function should be monitored carefully before and during DM to detect and manage early this adverse event.
authors.affiliation: Centre François Baclesse, Caen F-14000, France. Electronic address: marion.sassier@hotmail.fr.
authors.forename: Marion
authors.initials: M
authors.lastname: Sassier
authors.affiliation: Centre François Baclesse, Caen F-14000, France. Electronic address: audrey.dugue@baclesse.unicancer.fr.
authors.forename: Audrey Emmanuelle
authors.initials: AE
authors.lastname: Dugué
authors.affiliation: Centre François Baclesse, Caen F-14000, France. Electronic address: b.clarisse@baclesse.unicancer.fr.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Clarisse
authors.affiliation: Centre François Baclesse, Caen F-14000, France. Electronic address: paul.lesueur89@gmail.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Lesueur
authors.affiliation: Centre Léon Bérard, Lyon F-69008, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Avrillon
authors.affiliation: Centre Hospitalier Départemental, La Roche Sur Yon F-85000, France.
authors.forename: Acya
authors.initials: A
authors.lastname: Bizieux-Thaminy
authors.affiliation: Centre Hospitalier F. Quesnay, Mantes La Jolie F-78200, France.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Auliac
authors.affiliation: Centre Hospitalier Public du Cotentin, Cherbourg-Octeville F-50100, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Kaluzinski
authors.affiliation: Centre Hospitalier, Dieppe F-76200, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Tillon
authors.affiliation: Centre Hospitalier Régional Universitaire, Brest F-29200, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Robinet
authors.affiliation: Centre Hospitalier, Draguignan F-83300, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Le Caer
authors.affiliation: Centre Hospitalier Intercommunal, Créteil F-94000, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Monnet
authors.affiliation: Institut Paoli Calmettes, Marseille F-13009, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Madroszyk
authors.affiliation: Centre Hospitalier, Vire F-14500, France.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Boza
authors.affiliation: Centre Hospitalier, Villefranche Sur Saône F-69400, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Falchero
authors.affiliation: Institut de Cancérologie Lucien Neuwirth, Saint-Priest en Jarez F-42270, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Fournel
authors.affiliation: Centre Hospitalier Universitaire, Limoges F-87000, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Egenod
authors.affiliation: Centre Hospitalier Universitaire, Grenoble F-38000, France.
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Toffart
authors.affiliation: Centre François Baclesse, Caen F-14000, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Leiber
authors.affiliation: Centre François Baclesse, Caen F-14000, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Do
authors.affiliation: Centre François Baclesse, Caen F-14000, France. Electronic address: r.gervais@baclesse.unicancer.fr.
authors.forename: Radj
authors.initials: R
authors.lastname: Gervais
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D007677:Kidney Function Tests; D008175:Lung Neoplasms / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D060046:Maintenance Chemotherapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015995:Prevalence; D051437:Renal Insufficiency / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Bevacizumab; Non-small cell lung cancer; Pemetrexed; Renal insufficiency