Lu Shun, Cheng Ying, Zhou Cai-Cun, Wang Jie, Chih-Hsin Yang James, Zhang Ping-Hai, Zhang Xiao-Qing, Wang Xin, Orlando Mauro, Wu Yi-Long
Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Department of Oncology, Jilin Provincial Cancer Hospital, Changchun, China.
Clin Lung Cancer. 2016 Sep;17(5):e103-e112. doi: 10.1016/j.cllc.2016.04.003. Epub 2016 Apr 29.
Pemetrexed plus platinum has become a standard of care in first-line treatment for patients with advanced nonsquamous non-small-cell lung cancer. However, elderly lung cancer patients are generally understudied and undertreated in clinical practice in East Asia because of safety concerns. This analysis aimed to provide a picture of the clinical benefit of pemetrexed/platinum in the first-line setting for elderly (age ≥ 65 years) East Asian patients.
Individual patient data from 3 randomized controlled phase 3 trials that enrolled East Asian patients were analyzed in this meta-analysis.
In elderly East Asian patients (63 in the pemetrexed/platinum group and 42 in the control group), pemetrexed/platinum treatment achieved more benefits compared to other platinum-based doublets, including better overall response rate (32.8% vs. 7.5%), favorable progression-free survival (not statistically significant in adjusted hazard ratio), and significantly longer (3.15 vs. 1.54 months) survival without drug-related grade 3/4 toxicity. Overall survival was numerically prolonged (16.33 vs. 13.77 months; not statistically significant). These benefit trends were similar to those in all-age East Asian patients. In elderly East Asians, pemetrexed/platinum treatment was also associated with a lower incidence rate of drug-related grade 3/4 adverse events. The adverse event profile was similar to that in all-age East Asians. There were no unexpected adverse events.
Pemetrexed/platinum had good efficacy and also resulted in better overall response and tolerability than other platinum-based doublets as first-line treatment in nonsquamous non-small cell lung cancer in elderly East Asians, which was consistent with data observed in all-age East Asians.
培美曲塞联合铂类已成为晚期非鳞状非小细胞肺癌患者一线治疗的标准方案。然而，由于安全性担忧，东亚地区老年肺癌患者在临床实践中普遍研究不足且治疗不足。本分析旨在呈现培美曲塞/铂类在东亚老年（年龄≥65岁）患者一线治疗中的临床获益情况。
本荟萃分析纳入了3项纳入东亚患者的随机对照3期试验的个体患者数据。
在东亚老年患者中（培美曲塞/铂类组63例，对照组42例），与其他铂类双联方案相比，培美曲塞/铂类治疗带来了更多益处，包括更高的总缓解率（32.8%对7.5%）、良好的无进展生存期（调整后风险比无统计学意义），以及显著更长的无药物相关3/4级毒性生存期（3.15个月对1.54个月）。总生存期在数值上有所延长（16.33个月对13.77个月；无统计学意义）。这些获益趋势与所有年龄段的东亚患者相似。在东亚老年患者中，培美曲塞/铂类治疗还与较低的药物相关3/4级不良事件发生率相关。不良事件谱与所有年龄段的东亚患者相似。未出现意外不良事件。
在东亚老年非鳞状非小细胞肺癌患者中，培美曲塞/铂类作为一线治疗具有良好的疗效，且总体缓解和耐受性优于其他铂类双联方案，这与在所有年龄段东亚患者中观察到的数据一致。
