Original Article
The influence of pemetrexed-based continuous maintenance therapy on survival of locally advanced and metastatic lung adenocarcinoma
Abstract
Background: Patients may receive delayed maintenance therapy (stopping interval over 21 days) due to multi factors in the real-life setting. This retrospective study aims to collect data of pemetrexed-based continuous maintenance therapy, evaluate the impact of prolonged interval periods on clinical outcomes.
Methods: A total of 168 previously untreated stage IIIB or IV lung adenocarcinoma patients received induction chemotherapy with pemetrexed-platinum (PP) with or without antiangiogenesis inhibitors (bevacizumab or rh-endostatin) every 3 weeks for 4–6 cycles. Among them, 112 patients who did not show progression after induction chemotherapy completion were enrolled.
Results: Seventy of the 112 patients received continuous maintenance therapy with pemetrexed with or without antiangiogenesis inhibitors until disease progression; 42 patients did not receive continuous maintenance therapy. Multivariate analysis revealed that only lack of maintenance therapy was independently associated with shorter progression-free survival (PFS) [HR, 4.516 (2.332–8.744), P<0.001]. Brain metastases [HR, 4.263 (1.499–12.127), P=0.007] and lack of maintenance therapy [HR, 4.304 (1.566–11.825), P=0.005] were independent adverse prognostic factors for overall survival (OS). In the maintenance group, most patients delayed continuous maintenance treatment and the median interval between each maintenance therapy cycle was 40 days (range, 21–77 days). The median number of maintenance therapy cycles was 4 (range, 1–26). The best objective response rate (ORR) was higher in the maintenance group than in the non-maintenance group (48.6% and 33.3%). During a median follow-up of 14.6 months, patients in the maintenance group achieved significantly longer PFS (11.5 vs. 6.8 months, P<0.001) and OS (40.1 vs. 18.0 months, P=0.001) compared with those in the non-maintenance group.
Conclusions: Extending maintenance intervals is feasible and continuous maintenance therapy could offer survival benefit in patients who did not show progression after first-line induction treatment for lung adenocarcinoma.
Methods: A total of 168 previously untreated stage IIIB or IV lung adenocarcinoma patients received induction chemotherapy with pemetrexed-platinum (PP) with or without antiangiogenesis inhibitors (bevacizumab or rh-endostatin) every 3 weeks for 4–6 cycles. Among them, 112 patients who did not show progression after induction chemotherapy completion were enrolled.
Results: Seventy of the 112 patients received continuous maintenance therapy with pemetrexed with or without antiangiogenesis inhibitors until disease progression; 42 patients did not receive continuous maintenance therapy. Multivariate analysis revealed that only lack of maintenance therapy was independently associated with shorter progression-free survival (PFS) [HR, 4.516 (2.332–8.744), P<0.001]. Brain metastases [HR, 4.263 (1.499–12.127), P=0.007] and lack of maintenance therapy [HR, 4.304 (1.566–11.825), P=0.005] were independent adverse prognostic factors for overall survival (OS). In the maintenance group, most patients delayed continuous maintenance treatment and the median interval between each maintenance therapy cycle was 40 days (range, 21–77 days). The median number of maintenance therapy cycles was 4 (range, 1–26). The best objective response rate (ORR) was higher in the maintenance group than in the non-maintenance group (48.6% and 33.3%). During a median follow-up of 14.6 months, patients in the maintenance group achieved significantly longer PFS (11.5 vs. 6.8 months, P<0.001) and OS (40.1 vs. 18.0 months, P=0.001) compared with those in the non-maintenance group.
Conclusions: Extending maintenance intervals is feasible and continuous maintenance therapy could offer survival benefit in patients who did not show progression after first-line induction treatment for lung adenocarcinoma.
