Effectiveness and Safety of Pemetrexed Versus Docetaxel as a Treatment for Advanced Non-small Cell Lung Cancer: a Systematic Review and Meta-analysis

Abstract

Background: Our aim was to conduct a meta-analysis to compare the efficacy and safety of pemetrexed and docetaxel for non-small cell lung cancer (NSCLC). Materials and Methods: We systematically searched the Cochrane Library, PubMed, Embase, China Biology Medicine Database for randomized controlled trials (RCTs) comparing the efficacy and toxicities of pemetrexed versus docetaxel as a treatment for advanced NSCLC. We limited the languages to English and Chinese. Two reviewers independently screened articles to identify eligible trials according to the inclusion and exclusion criteria and assessed the methodological quality of included trials, and then extracted data. The meta-analysis was performed using STATA12.0. Results: Six RCTs involving 1,414 patients were identified. We found that there was no statistically significant differences in overall response rate, survival time, progression-free survival, disease control rate, and 1-2yr survival rate (p>0.050) but it is worthy of mention that patients in the pemetrexed arms had significantly higher 3-yr survival rate (P=0.002). With regard to the grade 3 or 4 hematological toxicity, compared with docetaxel, pemetrexed led to lower rate of grade 3-4 febrile neutropenia, neutropenia, and leukocyts toxicity (p<0.001). There was no significant difference in anemia between the two arms (p=0.08). In addition, pemetrexed led to higher rate of grade 3-4 thrombocytopenia toxicity (p=0.03). As for the non-hematological toxicities, compared with docetaxel, pemetrexed group had lower rate of grade 3-4 diarrhea and alopecia. Conclusions: Pemetrexed was almost as effective as docetaxel in patients with advanced NSCLC. At the same time, pemetrexed might increase the 3-yr survival rate. As for safety, pemetrexed led to lower rate of grade 3-4 febrile neutropenia, neutropenia, leukocytes, diarrhea and alopecia toxicity. However, it was associated with a higher rate of grade 3-4 thrombocytopenia.

Cost analysis of adverse events associated with non-small cell lung cancer management in France

“…Docetaxel, pemetrexed and erlotinib are considered for subsequent lines and treatment strategy takes into account histology, age and comorbidities. 5 These therapies may be associated with toxicities: 6 renal, neurologic and hematologic for platinum-based chemotherapy, 7 hematologic disorders and diarrhea for docetaxel and pemetrexed, 8 skin toxicity, diarrhea and interstitial lung disease for erlotinib. 6 Recently, pembrolizumab and nivolumab, two monoclonal antibodies that block the interaction between PD-1 expressed on tumor cells and PD-L1 receptors expressed on T cells, became new therapeutic options for NSCLC.…”

Efficacy and Survival-associated Factors with Gefitinib Combined with Cisplatin and Gemcitabine for Advanced Non-small Cell Lung Cancer

“…Gefitinib, EGFR tyrosine kinase inhibitor and aniline quinazoline compounds with low molecular weight, can competitively bind to EGFR tyrosine kinase and block EGFR-mediated tumor cell signaling, thus inhibiting the proliferation and metastasis, and angiogenesis of tumor and promoting the apoptosis of tumor cells (Fukuoka et al, 2011;Lee et al, 2013). With the application of new chemotherapeutics such as navelbine, paclitaxel, ene paclitaxel and gefitinib in clinic in recent years, the chemotherapy regimens of combined with cisplatin can greatly enhance the survival rate of advanced NSCLC (Heinermann, et al, 2009;Mill, et al, 2011;Natukula et al, 2013;Di et al, 2014). At present, gemcitabine combined with cisplatin is one of the standard first-line regimens for advanced SNCLC, but with the most common adverse reactions of combined chemotherapy such as myelosuppression and part of late patients difficult to tolerate (Giorgio et al, 2008).…”

IL-24 Inhibits Lung Cancer Growth by Suppressing GLI1 and Inducing DNA Damage

“…Lung cancer remains the leading cause of cancer-related death worldwide, despite extensive advances made in treatment approaches [1][2][3][4][5]. Drug resistance and metastasis make effective treatment strategies difficult [6].…”