Meta-Analysis of First-Line Pemetrexed Plus Platinum Treatment in Compared to Other Platinum-Based Doublet Regimens in Elderly East Asian Patients With Advanced Nonsquamous Non–Small-Cell Lung Cancer

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Abstract

Micro-Abstract

We performed a meta-analysis with maximum individual patient data from three phase 3 trials with data available for an elderly East Asian population to compare therapy with a pemetrexed plus platinum doublet with other platinum-based doublets as first-line treatment for nonsquamous non–small-cell lung cancer patients. Consistent with all-age East Asians, better tumor response and tolerability supports a preference for pemetrexed/platinum in elderly East Asians.

Background:

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.

Patients and Methods:

Individual patient data from 3 randomized controlled phase 3 trials that enrolled East Asian patients were analyzed in this meta-analysis.

Results:

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.

Conclusion:

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.

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