Pemetrexed, paclitaxel regimens equally effective in NSCLC

By Lynda Williams, Senior medwireNews Reporter

PointBreak trial results suggest that pemetrexed- and paclitaxel-based chemotherapy offer comparable survival outcomes and tolerability for patients with advanced nonsquamous non-small-cell lung cancer (NSCLC) but with differing toxicity profiles.

Patients with untreated stage IIIB or IV NSCLC were randomly assigned to receive up to four cycles of pemetrexed 500 mg/m² or paclitaxel 200 mg/m², alongside carboplatin area under the serum concentration-time curve 6 and bevacizumab 15 mg/kg every 3 weeks.

The pemetrexed and paclitaxel groups were then treated where possible with maintenance pemetrexed plus bevacizumab (PemCBev) or bevacizumab alone (PacCBev), respectively, explain Jyoti Patel (Northwestern University, Chicago, Illinois, USA) and co-authors.

Overall survival did not significantly differ between the 472 patients given the PemCBev regimen and the 467 patients given the PacCBev regimen, at a median of 12.6 and 13.4 months, respectively.

The 2-year survival rates were also similar for the PemCBev and PacCBev groups, at 24.4% and 21.2%, respectively.

However, progression-free survival was significantly longer in the PemCBev than PacCBev treatment groups, at 6.0 versus 5.6 months and a hazard ratio of 0.83.

This finding “suggests that the PemCBev combination had a positive effect in this trial, although this did not translate into an [overall survival] advantage,” Patel et al comment in the Journal of Clinical Oncology.

Of note, patients given the PacCBev regimen were more likely than PemCBev-treated patients to experience grade 3 or 4 neutropenia (40.6 vs 25.8%), febrile neutropenia (4.1 vs 1.4%), and sensory neuropathy (4.1 vs 0.0%), as well as grade 1 or 2 alopecia (36.8 vs 6.6%).

By contrast, PemCBev was associated with a significantly higher rate of grade 3 or 4 drug-related thrombocytopenia (23.3 vs 5.6%), anemia (14.5 vs 2.7%), and fatigue (10.9 vs 5.0%) than PacCBev.

Patients in the PemCBev and PacCBev groups were equally likely to be admitted to hospital due to treatment-related adverse events (19.7 vs 19.0%), although the PemCBev regimen was associated with a significantly longer stay (8.5 vs 6.3 days).

Treatment-related deaths were comparable between the PemCBev and PacCBev groups, in both number (8 vs 10) and cause.

Patel and co-workers therefore conclude: “The similar efficacy seen in this study between treatment arms and compared with other platinum doublet therapy allows clinicians to choose a therapy… on the basis of [a] specific patient’s clinical situation and tolerance to toxicity.”

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