Open AccessTumor response and clinical toxicity associated with second‐line chemotherapy regimens for advanced non‐squamous non‐small cell lung cancer: A retrospective cohort study
Author(s) -
Hu Chengping,
Wang Yan,
Chen Jianhua,
Wu Shengqi,
Li Xiaoling,
Wang Yuqin,
Yang Yicheng,
Rajan Narayan,
Papadimitropoulos Manny,
Xiao Qiong,
Zhan Huan,
Chen Wendong
Publication year - 2014
Publication title -
thoracic cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 28
eISSN - 1759-7714
pISSN - 1759-7706
DOI - 10.1111/1759-7714.12102
Subject(s) - pemetrexed , docetaxel , medicine , oncology , lung cancer , neutropenia , chemotherapy , retrospective cohort study , febrile neutropenia , cisplatin
Background 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 C hina. Methods A retrospective cohort study was conducted including patients receiving pemetrexed or docetaxel‐based chemotherapy in the second‐line setting for advNS‐NSCLC in four C hinese 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. Results 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. Conclusions 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 C hinese patients. Pemetrexed monotherapy had comparable tumor response, but significantly less hematological toxicity than pemetrexed‐based doublet.