Effectiveness and Safety of Pemetrexed Versus Docetaxel as a Treatment for Advanced Non-small Cell Lung Cancer: a Systematic Review and Meta-analysis

Background: Our aim was to conduct a meta-analysis to compare the efficacy and safety of pemetrexedand docetaxel for non-small cell lung cancer (NSCLC). Materials and
Methods: We systematically searchedthe Cochrane Library, PubMed, Embase, China Biology Medicine Database for randomized controlled trials(RCTs) comparing the efficacy and toxicities of pemetrexed versus docetaxel as a treatment for advancedNSCLC. We limited the languages to English and Chinese. Two reviewers independently screened articles toidentify eligible trials according to the inclusion and exclusion criteria and assessed the methodological qualityof included trials, and then extracted data. The meta-analysis was performed using STATA12.0.
Results: SixRCTs involving 1,414 patients were identified. We found that there was no statistically significant differencesin overall response rate, survival time, progression-free survival, disease control rate, and 1-2yr survival rate(p>0.050) but it is worthy of mention that patients in the pemetrexed arms had significantly higher 3-yr survivalrate (P=0.002). With regard to the grade 3 or 4 hematological toxicity, compared with docetaxel, pemetrexedled to lower rate of grade 3-4 febrile neutropenia, neutropenia, and leukocyts toxicity (p<0.001). There was nosignificant difference in anemia between the two arms (p=0.08). In addition, pemetrexed led to higher rate ofgrade 3-4 thrombocytopenia toxicity (p=0.03). As for the non-hematological toxicities, compared with docetaxel,pemetrexed group had lower rate of grade 3-4 diarrhea and alopecia.
Conclusions: Pemetrexed was almost aseffective as docetaxel in patients with advanced NSCLC. At the same time, pemetrexed might increase the 3-yrsurvival rate. As for safety, pemetrexed led to lower rate of grade 3-4 febrile neutropenia, neutropenia, leukocytes,diarrhea and alopecia toxicity. However, it was associated with a higher rate of grade 3-4 thrombocytopenia.