title: Take-home message in times of crisis: Is it really better to treat with cisplatin & pemetrexed than cisplatin & gemcitabine in first line NSCLC? The power of statistical considerations.
abstract: During the last decade, the cost of healthcare in oncology is world widely increased both for new drugs and even for traditional chemotherapy when new criteria for selection of patients, for example histology, are applied. Physicians are one of the principal actors in the field, having the initial responsibility to understand and interpret the scientific results in order to reduce the pharmaco-economic impact. Platinum-based doublet chemotherapy is the standard of care in advanced unselected population of Non Small cell Lung cancer (NSCLC) patients. Since the data of pemetrexed in combination with cisplatin were published, several oncologists chose this schedule as first choice in non squamous NSCLC. Another scheme, gemcitabine plus cisplatin, was the comparator for the pivotal study of pemetrexed. In this editorial we critically analyze the real data of this noninferiority study and the importance of statistical knowledge by oncologists for correct interpretation of study results.
authors.affiliation: Phase I-Early Clinical Trials Unit, Antwerp University Hospital and Center of Oncological Research (CORE), Antwerp University, Belgium. Electronic address: chirstian.rolfo@uza.be.
authors.forename: Christian
authors.initials: C
authors.lastname: Rolfo
authors.affiliation: Phase I-Early Clinical Trials Unit, Antwerp University Hospital and Center of Oncological Research (CORE), Antwerp University, Belgium.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Castañon
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D000068437:Pemetrexed / Q000008:administration & dosage; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000068437:Pemetrexed; D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine
keywords: First line chemotherapy; NSCLC; Pharmacoeconomics; Trial design