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Pemetrexed in the Treatment of Leptomeningeal Metastasis in Patients With EGFR-mutant Lung Cancer.
Clin Lung Cancer. 2019 07; 20(4):e442-e451.CL

Abstract

INTRODUCTION

Leptomeningeal metastasis (LM), still an area of unmet need, has frequently been observed in patients with EGFR-mutant non-small-cell lung cancer (NSCLC). Because the antitumor efficacy of systemic cytotoxic agents against LM is unclear, we explored the role of pemetrexed in the treatment of patients with LM from EGFR-mutant NSCLC.

PATIENTS AND METHODS

We retrospectively reviewed the medical records of patients with LM from EGFR-mutant NSCLC treated between 2006 and 2016. Post-LM survival was evaluated as well as clinical factors.

RESULTS

In our patient cohort with EGFR-mutant NSCLC (n = 631), 17.4% (n = 110) developed LM. Their median post-LM survival was 5.7 months (95% confidence interval, [CI], 0.0-12.0 months). Post-LM survival was significantly longer with pemetrexed use after LM (median, 13.7 months; 95% CI, 4.1-23.2 months) than without pemetrexed use after LM (median, 4.0 months; 95% CI, 2.2-5.7 months; P = .008). In the multivariate analyses, no pemetrexed use after LM (vs. use) and no EGFR tyrosine kinase inhibitor use after LM (vs. use) were independently associated with a poor post-LM survival with a hazard ratio of 3.1 (95% CI, 1.5-6.3; P = .002) and 3.0 (95% CI, 1.6-5.8; P = .001), respectively.

CONCLUSION

Pemetrexed use after LM was independently associated with a longer post-LM survival in patients with EGFR-mutant NSCLC with LM. Prospective studies are warranted to validate this finding.

Authors+Show Affiliations

Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. Electronic address: bhumsuk@snu.ac.kr.Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31010639

Citation

Choi, Mihong, et al. "Pemetrexed in the Treatment of Leptomeningeal Metastasis in Patients With EGFR-mutant Lung Cancer." Clinical Lung Cancer, vol. 20, no. 4, 2019, pp. e442-e451.
Choi M, Keam B, Ock CY, et al. Pemetrexed in the Treatment of Leptomeningeal Metastasis in Patients With EGFR-mutant Lung Cancer. Clin Lung Cancer. 2019;20(4):e442-e451.
Choi, M., Keam, B., Ock, C. Y., Kim, M., Kim, T. M., Kim, D. W., & Heo, D. S. (2019). Pemetrexed in the Treatment of Leptomeningeal Metastasis in Patients With EGFR-mutant Lung Cancer. Clinical Lung Cancer, 20(4), e442-e451. https://doi.org/10.1016/j.cllc.2019.03.005
Choi M, et al. Pemetrexed in the Treatment of Leptomeningeal Metastasis in Patients With EGFR-mutant Lung Cancer. Clin Lung Cancer. 2019;20(4):e442-e451. PubMed PMID: 31010639.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pemetrexed in the Treatment of Leptomeningeal Metastasis in Patients With EGFR-mutant Lung Cancer. AU - Choi,Mihong, AU - Keam,Bhumsuk, AU - Ock,Chan-Young, AU - Kim,Miso, AU - Kim,Tae Min, AU - Kim,Dong-Wan, AU - Heo,Dae Seog, Y1 - 2019/03/29/ PY - 2018/11/21/received PY - 2019/02/28/revised PY - 2019/03/21/accepted PY - 2019/4/24/pubmed PY - 2020/4/4/medline PY - 2019/4/24/entrez KW - Carcinomatous meningitis KW - Epidermal growth factor receptor KW - Leptomeningeal carcinomatosis KW - Non–small-cell lung cancer KW - Pemetrexed SP - e442 EP - e451 JF - Clinical lung cancer JO - Clin Lung Cancer VL - 20 IS - 4 N2 - INTRODUCTION: Leptomeningeal metastasis (LM), still an area of unmet need, has frequently been observed in patients with EGFR-mutant non-small-cell lung cancer (NSCLC). Because the antitumor efficacy of systemic cytotoxic agents against LM is unclear, we explored the role of pemetrexed in the treatment of patients with LM from EGFR-mutant NSCLC. PATIENTS AND METHODS: We retrospectively reviewed the medical records of patients with LM from EGFR-mutant NSCLC treated between 2006 and 2016. Post-LM survival was evaluated as well as clinical factors. RESULTS: In our patient cohort with EGFR-mutant NSCLC (n = 631), 17.4% (n = 110) developed LM. Their median post-LM survival was 5.7 months (95% confidence interval, [CI], 0.0-12.0 months). Post-LM survival was significantly longer with pemetrexed use after LM (median, 13.7 months; 95% CI, 4.1-23.2 months) than without pemetrexed use after LM (median, 4.0 months; 95% CI, 2.2-5.7 months; P = .008). In the multivariate analyses, no pemetrexed use after LM (vs. use) and no EGFR tyrosine kinase inhibitor use after LM (vs. use) were independently associated with a poor post-LM survival with a hazard ratio of 3.1 (95% CI, 1.5-6.3; P = .002) and 3.0 (95% CI, 1.6-5.8; P = .001), respectively. CONCLUSION: Pemetrexed use after LM was independently associated with a longer post-LM survival in patients with EGFR-mutant NSCLC with LM. Prospective studies are warranted to validate this finding. SN - 1938-0690 UR - https://www.unboundmedicine.com/medline/citation/31010639/Pemetrexed_in_the_Treatment_of_Leptomeningeal_Metastasis_in_Patients_With_EGFR_mutant_Lung_Cancer_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-7304(19)30078-6 DB - PRIME DP - Unbound Medicine ER -