Pemetrexed and cisplatin combination with concurrent whole brain radiotherapy in patients with brain metastases of lung adenocarcinoma: a single-arm phase II clinical trial

• Published in: Journal of neuro-oncology Vol. 112; no. 3; pp. 461 - 466
• Main Authors: Dinglin, Xiao-xiao, Huang, Yan, Liu, Hui, Zeng, Yin-duo, Hou, Xue, Chen, Li-kun
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-05-2013; Springer Nature B.V
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - secondary; Adenocarcinoma - therapy; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Brain Neoplasms - mortality; Brain Neoplasms - secondary; Brain Neoplasms - therapy; Chemoradiotherapy - methods; Cisplatin - administration & dosage; Cisplatin - adverse effects; Clinical Study; Cranial Irradiation; Disease-Free Survival; Female; Glutamates - administration & dosage; Glutamates - adverse effects; Guanine - administration & dosage; Guanine - adverse effects; Guanine - analogs & derivatives; Humans; Kaplan-Meier Estimate; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Oncology; Pemetrexed; Proportional Hazards Models; Chemotherapy; Brain metastases; Lung adenocarcinoma; WBRT; Pemetrexed
• ISSN: 0167-594X; 1573-7373
• DOI: 10.1007/s11060-013-1079-5

Pemetrexed-based chemotherapy presented about 40 % response rate (RR) on brain lesions of non-small cell lung cancer (NSCLC). But whole brain radiotherapy (WBRT) is still the standard treatment when surgery or radio-surgery is not feasible. This trial evaluated the efficacy and safety and efficacy of pemetrexed-cisplatin plus concurrent WBRT in this population. Forty-two patients were enrolled this study. Patients with newly diagnosed NSCLC with brain metastasis (BM) and performance status (PS) 0–2 were eligible for WBRT. Patients received up to six cycles of cisplatin and pemetrexed (75 and 500 mg/m
2
, respectively) every 3 weeks. On day 1–12 during the first cycle of chemotherapy, patients received WBRT 30 Gy/10 fx/12 days. Primary end point was objective RR and progression free survival (PFS) on BM. Secondary end points included extracerebral and overall RR, survival and safety profile. Forty-one were evaluable for response. The histology was all adenocarcinoma. The objective cerebral RR (complete and partial response) in the intent-to-treat population was 68.3 % (28 of 41 patients). Extracerebral and overall RR was 34.1 and 36.6 %, respectively. Progression free survival of BM was 10.6 months, and median overall survival was 12.6 months. The combined treatment with pemetrexed-cisplatin and concurrent WBRT are effective in patients with NSCLC with newly diagnosed BM. This modality of treatment appears to be particularly favorable in RR and progression free survival of BM. Further clinical studies are warranted.