title: Tumor response and clinical toxicity associated with second-line chemotherapy regimens for advanced non-squamous non-small cell lung cancer: A retrospective cohort study.
abstract: Previously reported superior tumor response of pemetrexed in the second-line setting for advanced non-squamous non-small cell lung cancer (advNS-NSCLC) has never been confirmed in real-world studies. Platinum-based doublet is frequently used in the second-line setting for advanced NSCLC in China.
  
  
  
  A retrospective cohort study was conducted including patients receiving pemetrexed or docetaxel-based chemotherapy in the second-line setting for advNS-NSCLC in four Chinese tertiary care hospitals. Propensity score matched treatment groups were created for head-to-head comparisons on best tumor response and clinical toxicity. Multiple regression analyses were performed to rank the impact of the four regimens on the risks of tumor progression and hematological adverse events.
  
  
  
  Three hundred and eighty-four patients were included for creating matched treatment groups for pemetrexed versus platinum/pemetrexed (33 pairs), docetaxel (17 pairs), and platinum/docetaxel (29 pairs), respectively. No significant differences were identified for best tumor response between pemetrexed and the other three regimens. However, pemetrexed was associated with significantly fewer patients experiencing anemia (39.4% vs. 69.7%, P = 0.004) and neutropenia (6.1% vs. 30.3%, P = 0.021) than platinum/pemetrexed. Multiple regression analyses indicated that pemetrexed was associated with significantly slower tumor progression (hazard ratio 0.628, P = 0.040) and a significantly lower risk of neutropenia (odds ratio 0.132, P = 0.019) than docetaxel.
  
  
  
  Pemetrexed was associated with significantly postponed tumor progression and significantly less hematological toxicity than docetaxel in the real-world second-line setting for advNS-NSCLC in Chinese patients. Pemetrexed monotherapy had comparable tumor response, but significantly less hematological toxicity than pemetrexed-based doublet.
authors.affiliation: Department of Respiratory, Xiangya Hospital, Central South University Changsha, China.
authors.forename: Chengping
authors.initials: C
authors.lastname: Hu
authors.affiliation: Department of Medical Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Medical Oncology, Hunan Province Tumor Hospital, Central South University Changsha, China.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Research and Education, Hunan Province Tumor Hospital, Central South University Changsha, China.
authors.forename: Shengqi
authors.initials: S
authors.lastname: Wu
authors.affiliation: Department of Pharmacy, Xuanwu Hospital, Capital Medical University Beijing, China.
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Pharmacy, Xuanwu Hospital, Capital Medical University Beijing, China.
authors.forename: Yuqin
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Lilly Suzhou Pharmaceutical Co., Ltd. Shanghai Branch Shanghai, China.
authors.forename: Yicheng
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Global Health Outcomes Research, Eli Lilly Indianapolis, Indiana, USA.
authors.forename: Narayan
authors.initials: N
authors.lastname: Rajan
authors.affiliation: Global Health Outcomes Research, Eli Lilly Indianapolis, Indiana, USA; Division of Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto Toronto, Canada.
authors.forename: Manny
authors.initials: M
authors.lastname: Papadimitropoulos
authors.affiliation: Health Outcomes Research, Normin Health Changsha Representative Office Changsha, China.
authors.forename: Qiong
authors.initials: Q
authors.lastname: Xiao
authors.affiliation: Health Outcomes Research, Normin Health Changsha Representative Office Changsha, China.
authors.forename: Huan
authors.initials: H
authors.lastname: Zhan
authors.affiliation: Division of Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto Toronto, Canada; Normin Health Toronto, Canada.
authors.forename: Wendong
authors.initials: W
authors.lastname: Chen
keywords: Adenocarcinoma; docetaxel; pemetrexed; platinum-based doublet; previously treated