The first direct comparison of treating nonsquamous lung cancer with either pemetrexed or docetaxel in addition to cisplatin has shown that the two combinations achieve similar progression-free survival, although docetaxel was associated with more frequent adverse events. This research was presented at the European Society for Medical Oncology (ESMO) 2014 Congress in Madrid, Spain.

The open-label phase III trial included 149 patients with nonsquamous non-small cell lung cancer (NSCLC) conducted at 14 centers in South Korea. The results were reported by Young-Chul Kim, MD, PhD, from Chonnam National University Medical School, South Korea.

“We wanted to conduct this study because pemetrexed plus platinum chemotherapy is the most commonly used regimen for treating patients with nonsquamous NSCLC whose cancer does not have mutations that can be targeted by specific inhibitors,” Kim explained.

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“However, docetaxel plus platinum is another effective regimen in the first line treatment of lung cancer and there has been no direct comparison of pemetrexed plus cisplatin versus docetaxel plus cisplatin.”

In the study, researchers randomly assigned patients with chemotherapy-naïve cancer to 3-weekly cisplatin 70 mg/m2 in addition to either docetaxel 60 mg/m2 or pemetrexed 500 mg/m2 for up to four cycles.

They recorded a median progression-free survival of 4.7 months in those who received the pemetrexed combination, and 4.6 months among those who received docetaxel.

However, the rate of serious adverse events was higher in the docetaxel group, they found, with 24 serious adverse events recorded among pemetrexed patients, and 42 in the docetaxel arm.

Kim notes that recruitment into the study was halted early when pemetrexed maintenance treatment was approved in Korea and its use became widespread. “As we stopped recruitment prematurely, we could not prove noninferiority between the arms. However, the pemetrexed plus cisplatin arm was less toxic than the docetaxel plus cisplatin arm, while there was no significant difference in progression-free survival and response rate,” Kim said.

The researchers are continuing to follow patients in the trial to study whether there is any difference in overall survival between the arms.

“The various available platinum-based regimens demonstrate quite similar activity in NSCLC,” commented Solange Peters, MD, PhD, from the University Hospital of Lausanne, Switzerland. He added, “While a dedicated larger trial published by Scagliotti in 2008 was able to show some superiority of platinum in combination with pemetrexed in nonsquamous NSCLC, this trial also confirms its better tolerability, reinforcing most current international NSCLC treatment guidelines.”