Pemetrexed as a Component of First-, Second- and Thirdline Chemotherapy in Treating Patients with Metastatic Lung Adenocarcinoma

Purpose: The current research was conducted to investigate the efficacy and safety of pemetrexed givencontinuously as a basement agent for first-, second- to third line chemotherapy of patients with metastatic lungadenocarcinoma. Patients and
Methods: Patients with metastatic lung adenocarcinoma who were diagnosed inJiangsu Cancer Hospital and Research Insitute, were enrolled. All received pemetrexed 500 mg/m2 (intravenous; onday 1), and another chemotherapieutic agent every 3 weeks until disease progression, or intolerable toxicity. Thenthe patients were changed to a second line chemotherapy that was still based on pemetrexed 500 mg/m2 and anotherchemotherapeutic agent differing from the first line example, until disease progression, or intolerable toxicity.When third line chemotherapy was needed, pemetrexed 500 mg/m2 and another new chemotherapeutic agentwere combined until disease progression. Evaluation of efficacy was conducted after two cycles of chemotherapyusing the Response Evaluation Criteria for Solid Tumors. Toxicity was recorded according to NCI Criteria forAdverse Events version 3.0.
Results: From January 2010 to September 2013, 15 patients were enrolled. Theirmedian age was 56 years (range 43 to 77 years). Eight patients were male and 7 female. Five patients (33.3%)achieved PR, while 6 patients (40.0%) remained stable, no CR on first line; and 1 PR (7.7%), 5 stable (38.5%)were recorded when pemetrexed was ordered in second line; 5 patients (41.7%) were stable after pemetrexedwas combined in third line; no complete response was observed. Main side effects were grade 1 to 2 neutrophilsuppression and thrombocytopenia. Other toxicities included elevated transaminase and oral mucositis, butno treatment related death occurred.
Conclusions: Pemetrexed continuously as a basement agent from first-,second- to third line chemotherapy is mildly effective in treating patients with metastatic lung adenocarcinomawith tolerable toxicity.