| Background and Objectives:Lung Cancer is a major public health problem all over the world. Of all the lung cancer patients, non-small cell lung cancer (NSCLC) comprises approximately 80%. Pemetrexed has been approved by U.S. Food and Drug Administration (FDA) as a second-line treatment for advanced NSCLC as well. However, whether pemetrexed was superior to other second-line treatments and targeted agents? Our aims to① Analysis the current situations of chemotherapy for NSCLC by the visualization methods.② Compare the efficacy of pemetrexed to docetaxel, which is a standard second-line chemotherapy agents.③ Observe the effectiveness and safety of pemetrexed and erlotinib, which is a small molecular targeted drugs.Methods:Main Chinese and English databases were searched and randomized controlled trials (RCT) of pemetrexed for advanced NSCLC were identified. The RCT of pemetrexed versus docetaxel for advanced NSCLC were included. Data extraction was performed by two independent reviewers. And Cochrane risk of bias assessment tool was used to assess the methodological quality of included studies. Meta-analysis was calculated using RevMan5.1 software. Moreover, the advanced NSCLC patients treated with pemetrexed and erlotinib in Gansu province tumor hospital were included between January 2012 and December 2013. The effectiveness and safety were assessed using WHO statement. Analysis was performed using SPSS 16.0.Results:①The current situations of chemotherapy for NSCLC:the number of studies is increasing annually, and most of studies were published in 2012 and 2013.8685 authors were involved into the study, author participation number is 1.58 per capita. 75.07% of all the authors only published one paper. However author’s cooperation degree was higher, the main core team member has 88. In terms of published journal distribution, publications mainly focused on journals related thoracic tumor, only 2.59% of all publications were published in four top medical journals. The main research areas included Europe, North America and east Asia. In terms of research topic, mainly focused on the chemotherapy, radiation and chemotherapy, chemotherapy and radiotherapy used in combination with other anticancer drugs, etc. In addition, gene therapy, tumor vaccine, physical therapy, DNA repair, joint targeted therapy, and non-small cell lung cancer complicated with other parts of the malignant tumors will become the focus in the future.② The results of meta-analysis of comparing pemetrexed to docetaxel:compared docetaxel, the differences of pemetrexed in improving total effective rate (RR=1.67,95%:0.43-6.43; P=0.46) and total survival time (RR=0.64,95%:0.32-1.28; P=0.21), disease progression (P=0.175), and 1-2 years survival rate for patients with NSCLC were not significant. However, pemetrexed had a lower incidences of febrile neutropenia (Ⅲ-Ⅳ), neutrophil decrease(Ⅲ-Ⅳ), leukopenia (Ⅲ-Ⅳ), diarrhea (Ⅲ-Ⅳ) and alopecia (Ⅲ-Ⅳ). ③ The clinical observation of pemetrexed:retrospectively analysis 68 patients with stage IIIB and IV NSCLC. Compared with pemetrexed, the overall response rate,1 year survival rate and progression-free survival for erlotinib were similar. But in terms of reducing the incidences of adverse events, pemetrexed mainly caused hematology toxicity, mainly embodied in anemia, thrombocytopenia, and neutropenia. And the non-hematology toxicity were found for erlotinib, mainly included bone marrow suppression, mucositis, vomiting and rashes and so on, and the incidences of adverse events were lighter regarding erlotinib. The differences of two groups were statistically significant in the incidences of anemia, skin rashes, and fatigue aspect.Conclusions:Pemetrexed was almost as effective as docetaxel in patients with advanced NSCLC. At the same time, pemetrexed had lower the incidences of adverse events. Compared with erlotinib, pemetrexed has no obvious difference in efficacy indexes, but there were more incidences of rash, fatigue, and anemia. The conclusion still needed to be confirmed by more large sample size, rigorous RCT. |
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