Comparing first‐line treatment patterns and clinical outcomes of patients with pan‐negative advanced non‐squamous non‐small cell lung cancer

Abstract

BackgroundPlatinum‐based chemotherapy is the standard first‐line treatment for patients with advanced pan‐negative non‐squamous (non‐Sq) non‐small cell lung cancer (NSCLC). However, it is unknown which chemotherapy regimen confers the greatest benefit in such patients. This study explored which chemotherapy regimens were advantageous in non‐Sq NSCLC patients.MethodsA retrospective study was conducted on 114 patients with advanced non‐Sq NSCLC using platinum‐based chemotherapy in a first‐line setting between January 2013 and December 2015. The study evaluated the most common first‐line regimens including pemetrexed/platinum (PP), paclitaxel/carboplatin, gemcitabine/platinum, and vinorelbine/cisplatin. The primary endpoint was progression‐free survival (PFS), and secondary endpoints were the objective response rate and disease control rate (DCR). Univariate and multivariate logistic analysis was carried out.ResultsSixty of the 114 patients were administered PP regimens and 54 non‐pemetrexed plus platinum (NPP) regimens. The median PFS was significantly longer in the PP than in the NPP group (7.2 months, 95% confidence interval [CI] 5.3–9.1 vs. 4.9 months, 95% CI 3.2–6.6; P = 0.031). The DCR of the PP regimen was better than that of the NPP regimen (90.0% vs. 74.1%; P = 0.026). Smoking status was an independent predictor of PFS (hazard ratio 2.1, 95% CI 1.4–3.3; P = 0.001) in a final multivariate Cox regression model.ConclusionsA PP regimen tends to be more beneficial than an NPP regimen for patients with pan‐negative advanced non‐Sq NSCLC. Smoking status may be a valuable predictor for the selection of a chemotherapy regimen in such patients.

Prediction of veristrat test in first-line therapy of pemetrexed based regimen for advanced lung adenocarcinoma patients

“…In 2007, David Carbone etc initially established a VeriStrat method that can be used to predict the rst-line e cacy of EGFR tyrosine kinase inhibitor (TKI) for advanced NSCLC patients who did not receive EGFR mutation test before treatment. In this study, the median survival was 306 days in VS-G group of 69 patients, far more than 107 days in VS-P group of 27 patients [4]. A series of follow up studies demonstrated that VS is predictor of therapeutic bene t from EGFR TKI therapy [23].…”

“…Pemetrexed based therapy has been the standard rst-line chemotherapy regimen for advanced nonsquamous NSCLC patients without epidermal growth factor receptor (EGFR) sensitizing mutations, anaplastic lymphoma kinase (ALK) or c-ros oncogene 1 receptor kinase (ROS1) rearrangement. First-line pemetrexed based chemotherapy showed signi cant better outcomes than other chemotherapy regimens for these patients especially with gemcitabine/platinum [3][4][5]. Bevacizumab was a recombinant humanized monoclonal antibody which could bind vascular endothelial growth factor-A (VEGF-A), inhibit its binding to VEGF receptor-2, and then inhibit the biological effects of VEGF.…”

Prediction of the VeriStrat test in first-line therapy of pemetrexed-based regimens for advanced lung adenocarcinoma patients

“…In 2007, David Carbone et al initially used the VeriStrat method to predict the rst-line e cacy of EGFR tyrosine kinase inhibitors (TKIs) for advanced NSCLC patients who did not receive EGFR mutation tests before treatment. In this study, the median survival was 306 days in the VS-G group of 69 patients, far more than the 107 days in the VS-P group of 27 patients [4]. A series of follow-up studies demonstrated that VS is a predictor of therapeutic bene t from EGFR TKI therapy [23].…”

“…Pemetrexed-based therapy has been the standard rst-line chemotherapy regimen for advanced nonsquamous NSCLC patients without epidermal growth factor receptor (EGFR)-sensitizing mutations, anaplastic lymphoma kinase (ALK) or c-ros oncogene 1 receptor kinase (ROS1) rearrangement. First-line pemetrexed-based chemotherapy showed signi cantly better outcomes than other chemotherapy regimens for these patients, especially gemcitabine/platinum [3][4][5]. Bevacizumab is a recombinant humanized monoclonal antibody that can bind vascular endothelial growth factor-A (VEGF-A), inhibit its binding to VEGF receptor-2, and inhibit the biological effects of VEGF.…”

Prediction of Veristrat Test in First-Line Therapy of Pemetrexed Based Regimen for Advanced Lung Adenocarcinoma Patients

“…Pemetrexed based therapy has been the standard rst-line chemotherapy regimen for advanced nonsquamous NSCLC patients without epidermal growth factor receptor (EGFR) sensitizing mutations, anaplastic lymphoma kinase (ALK) or c-ros oncogene 1 receptor kinase (ROS1) rearrangement. First-line pemetrexed based chemotherapy showed signi cant better outcomes than other chemotherapy regimens for these patients especially with gemcitabine/platinum [3][4][5]. However some patients still showed primary resistance to pemetrexed regimen and progressed rapidly.…”