A Real-world Study Of Pemetrexed In First-line Treatment Of Advanced Non-squamous Non-small Cell Lung Cancer On The Efficacy And Safety

Objective:Lung cancer is the most common malignant tumor with the highest mortality and morbidity in the world.Non-squamous non-small cell lung cancer accounts for 79% of the total number in lung cancers.A large number of patients are mostly in the advanced stage when they are diagnosed as non-squamous non-small cell lung cancer.Pemetrexed as a multi-target anti-folate drug is the first-line treatment for non-small cell lung cancer chemotherapy.Most of phase II and III clinical trials have evaluated the efficacy and safety of pemetrexed in first-line treatment of advanced non-small cell lung cancer.Nevertheless,there is no relevant research in the real world.This study aims to explore the efficacy and safety of pemetrexed in patients with advanced non-squamous non-small cell lung cancer in the real world.Method: This study retrospectively analyzed 146 patients in advanced non-squamous non-small cell lung cancer using Pemetrexed(ALIMTA)from February 2012 to August 2017 in Hunan Cancer Hospital.According to different chemotherapy regimens,the patients were divided into 4 groups: PC-P group(pemetrexed combined with platinum chemotherapy 4 cycles of chemotherapy,pemetrexed maintenance therapy,),PCA-PA group(pemetrexed combined Platinum plus bevacizumab 4 cycles,pemetrexed combined with bevacizumab maintenance therapy,PC group(pemetrexed plus platinum chemotherapy 4 cycles,no maintenance therapy),PCA group(pemetrexed combination therapy with platinum-based chemotherapy combined with bevacizumab for 4 cycles without maintenance therapy).The end point of the study was median progression-free survival(PFS),secondary end point was overall survival(OS),and safety.Results: The median PFS of the PC-P,PCA-PA,PC,and PCA treatment groups was respectively 13 months,12 months,5 months,and 5 months;the median OS was respectively 27 months,21 months,15 months,and 11 months.Survival function analysis was performed among 146 patients.The 6-month overall survival rate was 87.6%,the 12-month overall survival rate was 68%,and the 24-month overall survival rate was 42.2%.Cox univariate and multivariate regression analysis showed that gender,age,histological type,PS score,EGFR mutation status,TNM stage,and smoking status were not significantly associated with PFS and OS(P>0.05).The treatment group was influencing factors of disease progression.Progression risk of both PC and PCA treatment groups are higher than PC-P treatment group.Conclusion: PC-P treatment group compared with PC treatment group,single drug maintenance treatment group data was significantly better than no maintenance treatment group.PCA-PA treatment group compared with PCA treatment group,double drug maintenance treatment group data was significantly better than no maintenance treatment Group.Univariate and multivariate regression analysis,clinical features and patient PFS,OS no significant association.