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Chemotherapy with or without pemetrexed as second-line regimens for advanced non-small-cell lung cancer patients who have progressed after first-line EGFR TKIs: a systematic review and meta-analysis

Authors Li ZH, Guo HY, Lu YY, Hu JX, Luo HT, Gu WG

Received 18 December 2017

Accepted for publication 29 March 2018

Published 27 June 2018 Volume 2018:11 Pages 3697—3703


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Prof. Dr. Geoffrey Pietersz

Zhihua Li,1,* Haiyan Guo,2,* Yiyu Lu,1 Jianxin Hu,1 Haitao Luo,1 Weiguang Gu1

1Department of Oncology, The People’s Hospital of Nanhai Foshan, Foshan, China; 2Department of Respiration, The People’s Hospital of Nanhai Foshan, Foshan, China

*These authors contributed equally to this work

Purpose: The development of acquired resistance to the first-line epidermal growth factor-tyrosine kinase inhibitor (EGFR-TKI) treatment in non-small-cell lung cancer (NSCLC) is inevitable, and most of these patients needed second-line chemotherapy. Furthermore, the optimum chemotherapeutic regimen is unclear. The aim of this meta-analysis was to evaluate the chemotherapeutic regimens “with-pemetrexed” versus “non-pemetrexed” in advanced NSCLC patients who had progressed after first-line EGFR-TKIs.
Materials and methods: We searched PubMed, Embase, Cochrane Library, and the Web of science for relevant clinical trials. Outcomes analyzed were response rate (RR), disease control rate (DCR), 1-year survival rate (1-year SR), progression-free survival (PFS), and overall survival (OS).
Results: One randomized controlled trial (RCT) and three retrospective studies were included in this meta-analysis, covering a total of 354 patients. The results showed that there was no significant difference between with-pemetrexed arm and non-pemetrexed arm in RR (OR 1.43, 95% CI 0.85–2.41, P=0.18), DCR (OR 1.5, 95% CI 0.94–2.39, P=0.09), and 1-year SR (OR 1.47, 95% CI 0.79–2.74, P=0.22). But the with-pemetrexed chemotherapeutic regimens significantly improved the PFS (HR 0.61, 95% CI 0.46–0.81, P=0.0005) and OS (HR 0.62, 95% CI 0.42–0.90, P=0.01).
Conclusion: The second-line with-pemetrexed chemotherapeutic regimens provided significantly longer PFS and OS than non-pemetrexed chemotherapeutic regimens. These findings indicate that the with-pemetrexed chemotherapeutic regimen may be an optimal second-line chemotherapeutic regimen for patients with advanced NSCLC following EGFR-TKI failure.

Keywords: lung cancer, chemotherapy, pemetrexed, EGFR TKIs, meta-analysis

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