The impact of induction chemotherapy on the outcome of second-line therapy with pemetrexed or docetaxel in patients with advanced non-small-cell lung cancer

• Published in: Annals of oncology Vol. 18; no. 3; pp. 453 - 460
• Main Authors: Weiss, GJ, Rosell, R, Fossella, F, Perry, M, Stahel, R, Barata, F, Nguyen, B, Paul, S, McAndrews, P, Hanna, N, Kelly, K, Bunn, PA
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.03.2007; Oxford Publishing Limited (England)
• Subjects: Adult; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic - therapeutic use; Antineoplastic agents; Antineoplastic Agents, Phytogenic - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; chemotherapy; Docetaxel; Female; Glutamates - therapeutic use; Guanine - analogs & derivatives; Guanine - therapeutic use; Humans; Kaplan-Meier Estimate; Lung Neoplasms - drug therapy; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Male; Medical sciences; Middle Aged; Neoplasm Staging; non-small-cell lung cancer; Pemetrexed; Pharmacology. Drug treatments; Pneumology; Proportional Hazards Models; Research Design; Retrospective Studies; Sex Factors; survival; Taxoids - therapeutic use; Time Factors; Treatment Outcome; Tumors of the respiratory system and mediastinum; Antineoplastic agent; Human; Lung disease; Prognosis; Respiratory disease; Induction; Lung cancer; Docetaxel; Malignant tumor; non-small cell lung carcinoma; Pemetrexed; Survival; Antifolate; Chemotherapy; Taxane derivatives; Bronchus disease; Advanced stage; Second line treatment; Antimitotic; non-small-cell lung cancer
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/annonc/mdl454

Background: Using data from a large phase III study of previously treated advanced non-small-cell lung cancer (NSCLC) that showed similar efficacy for pemetrexed and docetaxel, this retrospective analysis evaluates the impact of first-line chemotherapy on the outcome of second-line chemotherapy. Patients and methods: In all, 571 patients with advanced NSCLC were randomly assigned to receive pemetrexed 500 mg/m2 or docetaxel 75 mg/m2 on day 1 of a 21-day cycle. Comparisons were made based on type of first-line therapy [gemcitabine + platinum (GP), taxane + platinum (TP), or other therapies (OT)], response to initial therapy, time since initial therapy, and clinical characteristics. The two second-line treatment groups were pooled for this analysis due to similar efficacy and were assumed to have no interaction with the first-line therapies. Results: Baseline characteristics were generally balanced. By multivariate analysis, gender, stage at diagnosis, performance status (PS), and best response to first-line therapy significantly influenced overall survival (OS). Additional factors by univariate analysis, histology, and time elapsed from first- to second-line therapy significantly influenced OS. Conclusions: Future trials in the second-line setting should stratify patients by gender, stage at diagnosis, PS, and best response to first-line therapy.