Lung Cancer
Lung Cancer
5 years ago

Assessment of interfering factors and clinical risk associated with discontinuation of pemetrexed maintenance therapy in advanced non-squamous non-small cell lung cancer

Pemetrexed continuation maintenance therapy after induction with platinum-based chemotherapy is a standard treatment option for non-squamous non-small cell lung cancer (NSCLC) patients. However, discontinuation of maintenance therapy is still a challenge in clinical practice. We aimed to investigate interfering factors and clinical risk associated with discontinuation of pemetrexed maintenance therapy (PMT). Materials and methods Data of patients with locally advanced or metastatic non-squamous NSCLC who received PMT between December 2011 and October 2015 were retrospectively analyzed. Patients’ characteristics, performance status (PS), response and toxicity evaluation were collected. The reasons for PMT discontinuation were summarized. Progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan–Meier method and Cox proportional hazard model. Results Of the 220 patients included for final analysis, 132 patients (60.0%) continued PMT until disease progression. The patients over 60 years old (p =0.021), the patients with PS 2 at the initiation of PMT (p =0.005) and the patients experienced grade 3/4 toxicity during PMT (p <0.001) had a higher discontinuation rate. The reasons for PMT discontinuation were the regarding toxicity (39.8%), high intensity of hospital visit (17.0%), treatment cost (13.6%), patients’ preference (26.1%) and failure of pain control (3.4%). In univariate analysis, PS 0–1 at the initiation of PMT (5.6 versus 4.3 months, p =0.022) and PMT continuation (5.6 versus 4.3 months, p <0.001) were associated with improved PFS. And PMT continuation was associated with improved OS (19.2 versus 16.8 months, p =0.003) along with actionable mutations and PS 0–1 at the initiation of PMT. In multivariate analysis, PMT continuation (hazard ratio: 1.486; 95% CI: 1.050–2.104; p =0.025) was an independent prognostic factor regarding OS benefit assessed by Cox proportional hazard model. Conclusion Discontinuation of PMT is common in clinical practice. The survival benefit suggests that fit patients should be encouraged to continue PMT until disease progression.

Publisher URL: www.sciencedirect.com/science

DOI: S016950021730380X

You might also like
Discover & Discuss Important Research

Keeping up-to-date with research can feel impossible, with papers being published faster than you'll ever be able to read them. That's where Researcher comes in: we're simplifying discovery and making important discussions happen. With over 19,000 sources, including peer-reviewed journals, preprints, blogs, universities, podcasts and Live events across 10 research areas, you'll never miss what's important to you. It's like social media, but better. Oh, and we should mention - it's free.

  • Download from Google Play
  • Download from App Store
  • Download from AppInChina

Researcher displays publicly available abstracts and doesn’t host any full article content. If the content is open access, we will direct clicks from the abstracts to the publisher website and display the PDF copy on our platform. Clicks to view the full text will be directed to the publisher website, where only users with subscriptions or access through their institution are able to view the full article.