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DI-002 Pemetrexed: a first line setting evaluation study

Background Carcinoma of the lung is characterised by its poor prognosis, and therefore choosing the best treatment is crucial. Pemetrexed is approved for treatment of patients with locally advanced or metastatic Non-Small Cell Lung Carcinoma (NSCLC), in first or second lines. In Hospital Garcia de Orta (HGO) the use of pemetrexed has been mostly in the second-line setting. Purpose To evaluate the use of pemetrexed in first-line treatment in patients, with locally advanced or metastatic NSCLC, in HGO, in order to promote proper management of its use. Materials and methods In this study, conducted in August 2013, we included all patients who started pemetrexed in a first-line setting, between 2011 and 2012. All data were collected from the patient’s medical record: histology, presence of metastases, chemotherapy protocol and adverse effects. For each patient Progression Free Survival (PFS) and Overall Survival (OS) were assessed and compared with the values from the phase III trial that led to approval of pemetrexed in this indication. Results Over the period analysed, 10 patients had pemetrexed treatment combined with platinum in a first-line setting (6 men and 4 women) with a mean age of 52.20 ± 7.36 [42–66 years]. Considering the histology, 30% were adenocarcinoma, 30% were large cells and 40% were other types of cells. All patients had metastatic disease. Of these patients, only one remains free of progression and 7 patients have died. The results were 2.4 months for PFS and 7.2 months for OS. The most frequent adverse events were anaemia (30%), rash (10%), gastrointestinal disorders (10%) and thrombocytopenia (10%). Conclusions Based on this analysis, when used in a first-line setting in our hospital, pemetrexed had a PFS and OS lower than those published in the clinical trial (PFS = 5. 3 months, OS = 11 months). A possible explanation could be the average age of our patients, the lower than average age of the patients included in the trial, which could indicate the presence of more aggressive disease. No conflict of interest.