A retrospective analysis showed that a platinum combination with pemetrexed resulted in better disease control and improved survival in patients with non-small cell lung cancer who progressed following first-line treatment with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) compared with those treated with pemetrexed alone.1

Platinum-based combination therapy is recommended in patients who have failed first-line treatment with EGFR TKIs, however the question of which agent is best remains.

Investigators sought to determine the safety and efficacy of  pemetrexed compared with a combination of pemetrexed/platinum-based chemotherapy.

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Investigators analyzed 63 patients who received pemetrexed-based therapy after failure of an EGFR-TKI. Patients were treated with either with pemetrexed/platinum combination therapy (n=34) or pemetrexed 500 mg/m2 alone (n=29).

The pemetrexed-platinum group displayed higher overall response rate compared to the pemetrexed alone group (44.4% vs 25.9%, respectively; P=0.154) Disease control rates were also superior in the combination arm (75.0% vs 43.5%, respectively; P=0.017).

After 9.6 months, median progression-free survival was 5.2 months (95% CI: 3.8-6.7 months) in the pemetrexed-platinum group (P=0.096) and 2.7 months (95% CI: 1.5-3.9 months) in the pemetrexed group.

Median overall survival was 15.1 months (95% CI: 12.8-17.4 months) and 10.3 months (95% CI: 8.9-11.6 months), respectively (P=0.354).

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Common adverse events included fatigue, nausea, and neutropenia. Neutropenia only occurred within the pemetrexed-platinum group (18%; P=0.049), and none of the cases were febrile.

The authors concluded that a pemetrexed plus platinum regimen may be suitable as second-line therapy, but prospective, phase 2 studies are required to further assess its appropriateness.


  1. Lee SJ, Sun JM, Lee SH, et al. Pemetrexed plus platinum versus pemetrexed alone in non-small cell lung cancer patients who have progressed after first-line EGFR TKIs.[published online ahead of print September 3, 2015]. Lung Cancer. doi: 10.1016/j.lungcan.2015.08.020.