title: Feasibility of home delivery of pemetrexed in patients with advanced non-squamous non-small cell lung cancer.
abstract: OBJECTIVE
  To evaluate the feasibility and adherence to home delivery (HD) of pemetrexed maintenance treatment in patients with advanced non-squamous non-small cell lung cancer (nsqNSCLC).
  
  
  METHODS
  Exploratory, prospective, single-arm, Phase II study in advanced nsqNSCLC patients, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0/1 that did not progress after 4 first-line induction cycles of a platinum doublet. The first cycle of pemetrexed (500mg/m(2)) was hospital administered, further cycles were HD until progressive disease or discontinuation. Feasibility was assessed by the adherence rate to HD (probability of reversion to hospital administration or treatment discontinuation due to HD) as primary endpoint, and by health-related quality-of-life (HRQoL: EQ-5D, lung cancer symptom scale [LCSS]), satisfaction with HD, overall survival (OS), and safety.
  
  
  RESULTS
  52 patients (UK & Sweden) received a median of 4 (range 1-19) pemetrexed maintenance cycles. Adherence rate up to Cycle 6 was 98.0% (95% confidence interval [CI]: 86.4%, 99.7%). All but 2 patients remained on HD. 1 patient discontinued after Cycle 1 (patient decision), and 1 after Cycle 6 (non-compliance with oral dexamethasone). 87% (33/38) of the patients preferred home to hospital treatment and in 90% (28/31) of cases, physicians were satisfied with distant management of patients. During HD Cycles 2-4 mean change from baseline ranged from 3.0 to 7.7 for EQ-5D visual analog scale. The 6-month OS rate was 73% (95% CI: 58%, 83%). 1 patient had an HD-related adverse event (device-related infection, Grade 2) and 1 patient died after Cycle 1, before HD, due to a possibly drug-related atypical pneumonia.
  
  
  CONCLUSIONS
  HD of pemetrexed maintenance treatment in patients with advanced nsqNSCLC was feasible, safe, and preferred by patients, while maintaining HRQoL. Physicians were satisfied with distant patient management.
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: rohit.lal@gstt.nhs.uk.
authors.forename: R
authors.initials: R
authors.lastname: Lal
authors.affiliation: Karolinska Universitetsjukhuset, Solna, Sweden.
authors.forename: G N
authors.initials: GN
authors.lastname: Hillerdal
authors.affiliation: Maidstone and Tunbridge Wells NHS Trust, Maidstone, United Kingdom.
authors.forename: R N H
authors.initials: RN
authors.lastname: Shah
authors.affiliation: Calderdale & Huddersfield NHS Trust, Huddersfield, United Kingdom.
authors.forename: B
authors.initials: B
authors.lastname: Crosse
authors.affiliation: Birmingham Heartlands Hospital, Birmingham, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Thompson
authors.affiliation: Aberdeen Royal Infirmary, Aberdeen, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Nicolson
authors.affiliation: Universitetssjukhuset, Linköping, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Vikström
authors.affiliation: Nottingham University Hospitals NHS Trust, United Kingdom.
authors.forename: V A
authors.initials: VA
authors.lastname: Potter
authors.affiliation: Eli Lilly and Company, United States.
authors.forename: C
authors.initials: C
authors.lastname: Visseren-Grul
authors.affiliation: Eli Lilly and Company, United States.
authors.forename: M
authors.initials: M
authors.lastname: Lorenzo
authors.affiliation: Eli Lilly and Company, United States.
authors.forename: Y
authors.initials: Y
authors.lastname: D'yachkova
authors.affiliation: Eli Lilly and Company, United States.
authors.forename: N
authors.initials: N
authors.lastname: Bourayou
authors.affiliation: The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom.
authors.forename: Y J
authors.initials: YJ
authors.lastname: Summers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D005260:Female; D018718:Home Infusion Therapy; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009367:Neoplasm Staging; D000068437:Pemetrexed / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D000068437:Pemetrexed
keywords: Adherence; Home delivery; Maintenance; NSCLC; Pemetrexed; Quality of life