High response of second-line chemotherapy with pemetrexed or gemcitabine combined with carboplatin in patients with non-small-cell lung cancer experiencing progression following 6 months after concluding platinum-based chemotherapy

Abstract

Because of improved therapeutic results after first-line platinum-based chemotherapy in patients with stage IV non-small-cell lung cancer (NSCLC), second-line chemotherapy may be considered for a growing number of patients. Approximately, 10% of patients have an interval time after concluding first-line platinum-based chemotherapy greater than 6 months. These patients may achieve high tumor responses when platinum is again used in second-line treatment. Twenty-three patients experiencing progression following 6 months after concluding platinum-based chemotherapy were managed with second-line treatment with carboplatin combined with gemcitabine or pemetrexed. Overall response, progression-free survival (PFS), and overall survival (OS) after initiation of second-line treatment were calculated for all patients. Median PFS after first-line treatment was 12.6 months (95% confidence interval [95% CI], 10.4-14.7 months). Partial response was achieved in 7 of 23 patients, resulting in an overall response of 30.4% (95% CI, 11.6-49.0). Following initiation of second-line chemotherapy, median PFS was 5.9 months (95% CI, 1-10.9 months) and median OS was 12.5 months (95% CI, 3.5-21.5 months). The 1-year survival rate for all patients was 61.0% (95% CI, 29.5-82.0). Adding these results to those of the 10 previously published trials, 75 of 326 patients, 23%, (95% CI, 18.7-27.3) presented an overall response with the use of second-line platinum-based chemotherapy. The use of platinum combinations as second-line chemotherapy seems to have a place in the management of patients with advanced NSCLC, especially those with an interval time to progression greater than 6 months.

A prognostic model for platinum‐doublet as second‐line chemotherapy in advanced non‐small‐cell lung cancer patients

“…Interestingly, there was significantly improved OS for patients who had previous treatment more than 6 months before. Arrieta et al analyzed platinum rechallenge in 23 stage IV NSCLC patients who experiencing disease progression 6 months after platinum-based first-line chemotherapy, resulting a RR of 30.4%, a median PFS of 5.9 months, and a median OS of 12.5 months [15]. Lee et al evaluated the efficacy of pemetrexed plus oxaliplatin in platinum-resistant advanced NSLCL patients, and not surprisingly, no response was observed [16].…”

“…Arrieta et al. analyzed platinum rechallenge in 23 stage IV NSCLC patients who experiencing disease progression 6 months after platinum‐based first‐line chemotherapy, resulting a RR of 30.4%, a median PFS of 5.9 months, and a median OS of 12.5 months . Lee et al.…”

A Randomized Phase II Trial of Gemcitabine plus Carboplatin: Biweekly versus Standard Schedules in Patients with Advanced Non-Small Cell Lung Cancer

“…The GC regimen was tested in various situations of NSCLC patients, e.g. in an adjuvant setting, for elderly patients and as a second-line treatment for selected patients with encouraging effects [16,18,19,20,21]. In addition, acceptable toxicity and promising median overall survival rates were reported in the combination of GC and bevacizumab for nonsquamous NSCLC [22].…”

Randomized Phase II Study of Two Schedules of Carboplatin and Gemcitabine for Stage IIIB and IV Advanced Non-Small Cell Lung Cancer (JACCRO LC-01 Study)

“…Less toxic chemotherapy regimens will have the advantages to maintain the quality of life of the patients and to combine them with molecular targeted drugs. The CG combination was tested in various situations of NSCLC patients such as in an adjuvant setting, for the elderly and as a second line for selected patients, showing encouraging effects [13,14,15]. In addition, an acceptable toxicity and promising median overall survival was reported in the combination of CG and bevacizumab for Non-Sq NSCLC [16].…”