Randomized phase 3 open label study of quality of life of patients on Pemetrexed versus Erlotinib as maintenance therapy for advanced non squamous non EGFR mutated non small cell lung cancer

Abstract

Background: We planned to compare pemetrexed maintenance with erlotinib maintenance in non squamous non Epidermal Growth Factor Receptor (EGFR) mutated non small cell lung cancer (NSCLC). The null hypothesis for this study was that there would be no difference in quality of life (QOL) between pemetrexed and erlotinib maintenance. Results: The QL2 scores at 3 months were 63.35 (SD 24.99) in pemetrexed arm and 63.01(SD 23.04) in erlotinib arm (p-0.793). Except in 1 domain, the scores were statistically similar between the 2 arms. In the domain of diarrhea, the score was higher as expected in the erlotinib arm (p-0.048). The median progression free survival was 4.5 months (95%CI 4.1–4.9 months) in pemetrexed arm versus 4.5 months (95%CI 3.8–5.2 months) in erlotinib arm (p-0.94). The median overall survival was 16.6 months (15.2–17.9 months) in pemetrexed arm versus 18.3 months (95% CI 13.75–22.91 months) in erlotinib arm (p-0.49). Methods: The study was an open label, single centre, parallel, phase 3 randomized study with 1:1 randomization between maintenance pemetrexed arm and erlotinib arm. Adult patients (age > or = 18 years), with non squamous EGFR mutation, treated with first line palliative therapy, with non progressive disease post 4–6 cycles of pemetrexed-carboplatin were randomized. Primary outcome was change in the score of QOL (Global health status {QL2}) at 3 months. We estimated that with 200 patients, the study had 80% power to detect a significant difference between the two groups in the change in the global health status score at 3 months with an alpha error of 5%, with an effect size of 0.3 SD. Conclusions: Maintenance pemetrexed post pemetrexed-platinum chemotherapy fails to improve QOL or time to event outcomes over maintenance erlotinib in EGFR mutation negative NSCLC.

Leptomeningeal metastasis from non-small cell lung cancer – a post-hoc analysis from four randomised clinical trials

“…Patients with adenocarcinoma who were enrolled in the pemetrexed versus erlotinib maintenance trial (November 2014–March 2017) with quality of life being the primary end point [ 12 ].…”

“…These neuroimaging features were the unequivocal presence of leptomeningeal nodules or enhancement. The response to LMM was assessed in accordance with the RANO working group proposal [ 12 ]. OS was defined as the time in months from the date of diagnosis of LMM to the date of death.…”

“…There is very limited literature regarding the incidence, presentation symptoms, diagnostic modalities, treatment and outcomes of LMM with these novel therapies from LMICs. Over the last 5 years, we have reported four randomised studies in NSCLC from India [9][10][11][12]. These studies have contributed towards the improvement in outcomes of NSCLC.…”