© 2007 European Society for Medical Oncology
lung cancer |
The impact of induction chemotherapy on the outcome of second-line therapy with pemetrexed or docetaxel in patients with advanced non-small-cell lung cancer
1 Division of Medical Oncology, University of Colorado Health Sciences Center, Aurora, CO, USA
2 Catalan Institute of Oncology, Barcelona, Spain
3 MD Anderson Cancer Center, Houston, TX
4 University of Missouri, Ellis Fischel Cancer Center, Columbia, MO, USA
5 University Hospital Division of Medical Oncology, Zurich, Switzerland
6 Centro Hospitalar de Coimbra, Coimbra, Portugal
7 Eli Lilly and Company, Indianapolis, IN
8 Indiana University Medical Center, Indianapolis, IN, USA
* Correspondence to: Dr P. A. Bunn Jr, Division of Medical Oncology, University of Colorado Health Sciences Center, Aurora, CO, USA. Tel: +1 303-724-3152; Fax: +1 303-724-3162; E-mail: paul.bunn{at}uchsc.edu
Background: Using data from a large phase III study of previously treated advanced non-small-cell lung cancer (NSCLC) that showed similar efficacy for pemetrexed and docetaxel, this retrospective analysis evaluates the impact of first-line chemotherapy on the outcome of second-line chemotherapy.
Patients and methods: In all, 571 patients with advanced NSCLC were randomly assigned to receive pemetrexed 500 mg/m2 or docetaxel 75 mg/m2 on day 1 of a 21-day cycle. Comparisons were made based on type of first-line therapy [gemcitabine + platinum (GP), taxane + platinum (TP), or other therapies (OT)], response to initial therapy, time since initial therapy, and clinical characteristics. The two second-line treatment groups were pooled for this analysis due to similar efficacy and were assumed to have no interaction with the first-line therapies.
Results: Baseline characteristics were generally balanced. By multivariate analysis, gender, stage at diagnosis, performance status (PS), and best response to first-line therapy significantly influenced overall survival (OS). Additional factors by univariate analysis, histology, and time elapsed from first- to second-line therapy significantly influenced OS.
Conclusions: Future trials in the second-line setting should stratify patients by gender, stage at diagnosis, PS, and best response to first-line therapy.
Key words: chemotherapy, docetaxel, non-small-cell lung cancer, pemetrexed, survival
Received for publication July 16, 2006. Revision received October 29, 2006. Accepted for publication October 31, 2006.
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