New Treatment Combination for Lung Cancer Patients With Brain Metastases

The treatment combinations pemetrexed plus temozolomide (PT) and pemetrexed plus cisplatin (PC) are equally effective for the treatment of non-small cell lung cancer (NSCLC) with brain metastases, according to a recent study. However, PT is safer among this patient population.

For their study, the researchers evaluated patients with NSCLC with brain metastases from November 2013 to October 2015. After standard whole-brain radiotherapy (WBRT), all patients received high-dose pemetrexed (900 mg/m²) on day 1 of each 3-week cycle. A total of 32 patients were assigned to receive cisplatin on days 1 to 3 (PC group); and 28 received 75 mg/m² temozolomide orally with concurrent WBRT, followed by 150 mg/m² temozolomide on days 1 to 5 with high-dose pemetrexed (900 mg/m²) on day 1 of each 3-week cycle (PT group).
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In both groups, high-dose pemetrexed (900 mg/m²) monotherapy or the best available supportive therapy was administered 6 cycles later, and an evaluation was conducted every 2 to 3 cycles.

The researchers defined the primary outcomes as objective response rate (ORR), progression-free survival, and overall survival, and the secondary outcomes were defined as safety and tolerability.

Results indicated that the ORR was 68.8 in the PC group and 75% in the PT group, with no statistically significant difference between the groups. Median progression-free survival rates were 13.6 months in the PC group and 16.9 months in the PT group. Median overall survival rates were 18.9 months in the PC group and 19.3 months in the PT group. There were no differences in progression-free survival and overall survival between the groups.

Additionally, the researchers observed no grade 4 or higher adverse effects in either group. However, in the PC group, grade 3 adverse effects such as leucopenia, nausea and vomiting, alopecia, rash, and renal insufficiency were observed. The only grade 3 adverse effects observed in the PT group were leucopenia, nausea, and vomiting.

“The data showed that the PT group achieved the same efficacy in [progression-free survival] and [overall survival] as the PC group but with fewer toxicities,” the researchers concluded. “Therefore, high-dose pemetrexed plus temozolomide may be a better regimen for treating NSCLC with [brain metastases] due to its better safety.”

—Christina Vogt

Reference:

He Q, Bi X, Ren C, et al. Phase II study of the efficacy and safety of high-dose pemetrexed in combination with cisplatin versus temozolomide for the treatment of non-small cell lung cancer with brain metastases. Anticancer Res. 2017;37(8):4711-4716. http://ar.iiarjournals.org/content/37/8/4711.abstract.