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Pemetrexed for the treatment of non-small cell lung cancer
Carlo Genova1, Erika Rijavec, Anna Truini
1IRCCS AOU San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Lung Cancer Unit, Genova, Italy. francesco.grossi@istge.it
Introduction:
Non-small cell lung cancer (NSCLC) is a major cause of cancer-related death worldwide. Although advanced NSCLC is still incurable, various anti-neoplastic agents have become available for the treatment of this disease. Pemetrexed , a multi-target folate antagonist, has improved the survival of non-squamous NSCLC patients. Currently, pemetrexed is approved for first-line treatment in combination with a platinum derivate, for second-line treatment as a single agent and, more recently, as maintenance treatment after first-line chemotherapy.
Areas Covered:
The authors analyzed the state of the art of pemetrexed through a review of the literature. Clinical trials and meta-analyses involving pemetrexed in NSCLC were evaluated. Pemetrexed improved survival of non-squamous NSCLC in first-line, maintenance, and second-line treatments; this benefit is limited to non-squamous histology. Because pemetrexed has become part of the standard of care, current clinical trials are designed to compare it to other investigational combinations. Limited data on resectable disease are available, and additional clinical trials are being conducted.
Expert Opinion:
Pemetrexed has shown effectiveness and a favorable toxicity profile. Histology-driven indications and the relationship of pemetrexed with thymidylate synthase expression suggest that a more precise definition of predictive biomarkers could be further investigated.
Insights
Pemetrexed improves survival for non-squamous non-small cell lung cancer (NSCLC) patients across various treatment lines. Further research into predictive biomarkers is recommended for personalized therapy.
Area of Science:
- Oncology
- Pharmacology
Background:
- Non-small cell lung cancer (NSCLC) is a leading cause of cancer mortality globally.
- Pemetrexed, a folate antagonist, offers improved survival for specific NSCLC patient groups.
Purpose of the Study:
- To review the current evidence and clinical applications of pemetrexed in NSCLC treatment.
- To evaluate the efficacy and safety of pemetrexed in different treatment settings.
Main Methods:
- Literature review of clinical trials and meta-analyses on pemetrexed in NSCLC.
- Analysis of pemetrexed's role in first-line, second-line, and maintenance therapy.
Main Results:
- Pemetrexed demonstrates survival benefits in non-squamous NSCLC across first-line, maintenance, and second-line settings.
- The efficacy of pemetrexed is histology-dependent, primarily benefiting non-squamous NSCLC.
- Pemetrexed exhibits a favorable toxicity profile, establishing it as a standard of care.
Conclusions:
- Pemetrexed is an effective treatment option for non-squamous NSCLC with a good safety profile.
- Histology-specific indications and thymidylate synthase expression highlight the need for predictive biomarker research.
- Ongoing clinical trials are exploring pemetrexed in combination therapies and for resectable disease.
