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Randomized Phase II Study of Pemetrexed Versus Gefitinib in Previously Treated Patients with Advanced Non-small Cell Lung Cancer

Cancer Research and Treatment
2016년 48권 1호 p.80 ~ p.87
 ( Kim Young-Saing ) - Gachon University Gil Medical Center Department of Internal Medicine Division of Hematology and Oncology

조은경 ( Cho Eun-Kyung ) - Gachon University Gil Medical Center Department of Internal Medicine Division of Hematology and Oncology
우현선 ( Woo Hyun-Sun ) - Gachon University Gil Medical Center Department of Internal Medicine Division of Hematology and Oncology
홍준식 ( Hong Jun-Shik ) - Gachon University Gil Medical Center Department of Internal Medicine Division of Hematology and Oncology
안희경 ( Ahn Hee-Kyung ) - Gachon University Gil Medical Center Department of Internal Medicine Division of Hematology and Oncology
박인근 ( Park In-Keun ) - Gachon University Gil Medical Center Department of Internal Medicine
심선진 ( Sym Sun-Jin ) - Gachon University Gil Medical Center Department of Internal Medicine Division of Hematology and Oncology
경선영 ( Kyung Sun-Young ) - Gachon University Gil Medical Center Department of Internal Medicine Division of Pulmonary and Critical Care Medicine
강신명 ( Kang Shin-Myung ) - Gachon University Gil Medical Center Department of Internal Medicine Division of Pulmonary and Critical Care Medicine
박정웅 ( Park Jeong-Woong ) - Gachon University Gil Medical Center Department of Internal Medicine Division of Pulmonary and Critical Care Medicine
정성환 ( Jeong Sung-Hwan ) - Gachon University Gil Medical Center Department of Internal Medicine Division of Pulmonary and Critical Care Medicine
박진희 ( Park Jin-Ny ) - Gachon University Gil Medical Center Department of Internal Medicine Division of Hematology and Oncology
이재훈 ( Lee Jae-Hoon ) - Gachon University Gil Medical Center Department of Internal Medicine Division of Hematology and Oncology
신동복 ( Shin Dong-Bok ) - Gachon University Gil Medical Center Department of Internal Medicine Division of Hematology and Oncology

Abstract

Purpose : This study aimed to evaluate the efficacy and safety of pemetrexed versus gefitinib in patients with advanced non-small cell lung cancer (NSCLC) previously treated with chemotherapy.

Materials and Methods : Patients with advanced (stage IIIB or IV) or recurrent NSCLC were randomly assigned to receive either 500 mg/m² of pemetrexed intravenously every 3 weeks or gefitinib 250 mg/day orally. The primary end point was progression-free survival (PFS) at 6 months.

Results : A total of 95 patients were enrolled (47 for pemetrexed and 48 for gefitinib). Most patients were male (72%) and current/ex-smokers (69%), and 80% had non-squamous cell carcinoma. The epidermal growth factor receptor (EGFR) mutation status was determined in 38 patients (40%); one patient per each arm was positive for EGFR mutation. The 6-month PFS rates were 22% and 15% for pemetrexed and gefitinib, respectively (p=0.35). Both arms showed an identical median PFS of 2.0 months and a median overall survival (OS) of 8.5 months. In EGFR wild-type patients, higher response rate (RR) and longer PFS as well as OS were achieved via pemetrexed compared with gefitinib, although there were no significant differences (RR: 39% vs. 9%, p=0.07; median PFS: 6.6 months vs. 3.1 months, p=0.45; median OS: 29.6 months vs. 12.9 months, p=0.62). Toxicities were mild in both treatment arms. Frequently reported toxicities were anemia and fatigue for pemetrexed, and skin rash and anorexia for gefitinib.

Conclusion : Both pemetrexed and gefitinib had similar efficacy with good tolerability as second-line treatment in unselected patients with advanced NSCLC. However, pemetrexed is considered more effective than gefitinib for EGFR wild-type patients.

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