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Poster display session

4400 - Real world data of practice patterns and outcomes for pemetrexed plus platinum as neoadjuvant chemotherapy in adenocarcinomas of lung from a tertiary cancer center of India: Looking beyond the usual paradigm

Date

09 Sep 2017

Session

Poster display session

Presenters

Akhil Kapoor

Citation

Annals of Oncology (2017) 28 (suppl_5): v457-v459. 10.1093/annonc/mdx379

Authors

A. Kapoor1, S. Zanwar1, A. Joshi1, V. Noronha1, V. Patil1, A. Chougule2, A. Mahajan3, P. Bhargava1, K. Prabhash1

Author affiliations

  • 1 Medical Oncology, Tata Memorial Hospital, 400012 - Mumbai/IN
  • 2 Medical Oncology (molecular Lab), Tata Memorial Hospital, 400012 - Mumbai/IN
  • 3 Radiodiagnosis, Tata Memorial Hospital, 400012 - Mumbai/IN
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Resources

Abstract 4400

Background

Neoadjuvant chemotherapy (NACT) is the standard of care in non-small cell lung cancers (NSCLC) with locally advanced N2 disease. There is scarcity of data for pemetrexed-platinum regimen as NACT. Also, aside from N2 disease, role of NACT in locally advanced NSCLCs for tumor downstaging is unclear.

Methods

Nonmetastatic adenocarcinomas of lung treated with pemetrexed-platinum based NACT were analysed. The patients with locoregionally advanced N2 disease and those who were borderline candidates for upfront definitive treatment were planned for NACT after discussion in a multidisciplinary clinic. Total 4 cycles of 3-weekly pemetrexed and platinum were delivered in combined neoadjuvant and adjuvant setting. Response assessment was done using RECIST criteria. Progression free (PFS) and overall survival (OS) were calculated using Kaplan Meier method.

Results

Out of 114 evaluable patients, 99 patients received NACT with pemetrexed-platinum. Most common indication for NACT was N2 disease at baseline (46.4%). Objective response rate was 38.2% (95% CI: 23%-53%) including two complete and 34 partial responses. 12.7% patients had progressive disease on NACT. Median PFS was 15 months (95% CI 11.6-18.4) and median OS was 22 months (95% CI 15.6-28.3) at a median follow-up of 16 months. There was a significant improvement in the OS of patients undergoing definitive therapy versus no definitive therapy (median OS 25 months [95% CI 19.4-30.3] vs 12 months [95% CI 3.2-20.3] respectively; p = 0.047, HR 1.6). Amongst patients who could not undergo definitive CTRT upfront due to dosimetric constraints (n = 36), 26 (72.2%) patients finally underwent CTRT after NACT. Those patients who were not able to undergo definitive CTRT had median PFS of 5 months [95% CI 2.1-7.9] versus 10 months [95% CI 3.8-16.1] in those who were made amenable to definitive CTRT post NACT; p = 0.018.

Conclusions

Pemetrexed-platinum based NACT appears to be an effective option and many borderline cases where upfront definitive therapy is not feasible may become amenable to the same after incorporation of NACT.

Clinical trial identification

Clinical Trials Registry India (registration number: CTRI/2013/01/003335)

Legal entity responsible for the study

Tata Memorial Hospital, Mumbai

Funding

None

Disclosure

All authors have declared no conflicts of interest.

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