1355 - Erythrocyte mean corpuscular volume change during pemetrexed treatment in advanced non small cell lung cancer patients

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Complications of Treatment
Non-Small-Cell Lung Cancer, Metastatic
Presenter Sebastiano Buti
Authors S. Buti1, P. Bordi2, M. Tiseo3, S. Panni4, S. Novello5, E. Bria6, S.G. Rapetti7, S. Pilotto8, R. Camisa2, A. Ardizzoni9
  • 1Oncologia, Azienda Ospedaliero-Universitaria di Parma, 43126 - Parma/IT
  • 2Oncologia Medica, Azienda Ospedaliero-Universitaria di Parma, IT-43100 - Parma/IT
  • 3Oncologia Medica, Azienda Ospedaliera di Parma, IT-43100 - Parma/IT
  • 4Oncologia, Azienda Istituti Ospitalieri di Cremona, 26100 - Cremona/IT
  • 5Department Of Clinical And Biological Sciences - Thoracic Oncology Unit, Azienda Ospedaliero-Universitaria ASOU San Luigi Gonzaga, 10043 - Orbassano (TO)/IT
  • 6Medical Oncology, Azienda Ospedaliera Universitaria Integrata Verona - "Borgo Roma", 37134 - Verona/IT
  • 7Department Of Clinical And Biological Sciences - Thoracic Oncology Unit, Azienda Ospedaliero-Universitaria ASOU San Luigi Gonzaga, 10043 - Orbassano/IT
  • 8Medical Oncology, Azienda Ospedaliera Universitaria Integrata Verona-"Borgo Roma", 37134 - Verona/IT
  • 9Oncologia Medica, Azienda Ospedaliero-Universitaria di Parma, 43126 - Parma/IT

Abstract

Introduction

Pemetrexed (Pem) has been approved for the treatment of advanced non small cell lung cancer (NSCLC) non-squamous histology, both as 1° and 2° line therapy with or without platinum compounds, respectively. Pem is an antimetabolite drug, that inhibits enzymes involved in nucleotides bio-synthesis arresting cancer cells cycle. Literature data show the effect of antimetabolities on increment of erythrocyte mean corpuscolar volume (MCV) in cancer patients (pts) treated with capecitabine and, recently, a positive correlation between increased MCV and response to capecitabine-based therapy has emerged [Arslan et al, Tumori 2011; Dellapasqua et al, Breast 2012]. The aim of this study was the evaluation of the impact of Pem on MCV change and its possible correlation with disease control rate (overall response + stable disease rate) (DCR), progression free survival (PFS) and overall survival (OS) in NSCLC pts.

Methods

A retrospective collection of clinical and laboratory data (including basal MCV and maximum MCV occurred during Pem therapy) in 165 advanced NSCLC pts treated with Pem from 4 Italian centres was performed.

Results

Pts characteristics: 59% men, median age 64 years (range 36-83), 58% ECOG PS 0, 90% stage IV and 10% stage IIIB (according 6th TNM), 87% adenocarcinoma histotype, 74% current or ex-smokers, 59% as 1° line, 41% as ≥ 2° line, 68% in combination with a platinum compound, median cycle 4 (range 1-29). All pts received vitamin B12 and folic acid supplementation. Mean MCV significantly increased from basal (89.6 fl) to “during treatment” (94.8 fl), with mean ΔMCV = 5.2 fl (t test for paired data, p < 0.0001). The median time from therapy start to maximum MCV was 2.3 months (mos). DCR was 84% and 62% [?2 test, p = 0.002], median PFS was 6.9 [CI95% 5.7-8.1] and 3.6 [CI95% 1.9-5.3] mos [p = 0.0019], and median OS was 16.0 [CI95% 7.9-24.1] and 10.8 [CI95% 9.0-12.6] mos [p = 0.0346], in ΔMCV > 5 fl (n = 68) and in ΔMCV ≤ 5 fl (n = 97) pts, respectively.

Conclusion

Pem induces significant increase of erythrocyte MCV. ΔMCV > 5 fl on Pem therapy appears to be correlated with better DCR, PFS and OS. These data should be related to a decreased metabolism of Pem and subsequent increased drug exposure in pts who develop higher ΔMCV during treatment. A larger prospective evaluation could be useful to better clarify these findings.

Disclosure

All authors have declared no conflicts of interest.