Phase II study of perioperative chemotherapy with cisplatin and pemetrexed in non-small-cell lung cancer

Grace K. Dy, Paul N. Bogner, Wei Tan, Todd L. Demmy, Aamer Farooq, Hongbin Chen, Saikrishna S. Yendamuri, Chukwumere E. Nwogu, Peter W. Bushunow, James Gannon, Araba A. Adjei, Alex A. Adjei, Nithya Ramnath

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

INTRODUCTION:: Pathologic complete response (pCR) with neoadjuvant chemotherapy is associated with improved survival in many solid tumors. We evaluated pCR rate of cisplatin with pemetrexed in non-small-cell lung cancer. METHODS:: Patients with stages IB to IIIA non-small-cell lung cancer, Eastern Cooperative Oncology Group performance status 0 to 1 were enrolled in this single-arm phase II trial using two-stage design with 90% power to detect pCR rate of more than or equal to 10%. Pretreatment mediastinal lymph node biopsy was required. Patients received three cycles of cisplatin 75 mg/m with pemetrexed 500 mg/m (day 1 every 21 days) preoperatively and additional two cycles within 60 to 80 days after surgery. The primary end point was pCR. Polymorphisms in FPGS, GGH, SLC19A1, and TYMS genes were correlated with treatment outcomes. RESULTS:: Thirty-eight patients were enrolled, with median age of 62.5 years. Preoperatively, 26% had squamous histology, and 34% had biopsy-proven N2 involvement. R0 resection was achieved in 94% of the 34 patients who underwent surgery, and 54% had documented N2 clearance. There was no pCR seen. Median disease-free survival (DFS) and overall survival of these patients have not yet been reached in contrast to median of 13.8 and 24.2 months, respectively, in patients with persistent N2 disease (p = 0.3241 and p = 0.1022, respectively). There was a statistically significant association between DFS and postoperative tumor, node, metastasis stage (p = 0.0429), SLC19A1 rs3788189 TT genotype (p = 0.0821), and viable tumor defined as less than or equal to 10% of resected specimen (p = 0.026). CONCLUSION:: The primary end point was not met. Patients with N2 clearance, less than or equal to 10% viable tumor in the resected specimen, and SLC19A1 rs3788189 TT genotype have favorable DFS outcomes.

Original languageEnglish (US)
Pages (from-to)222-230
Number of pages9
JournalJournal of Thoracic Oncology
Volume9
Issue number2
DOIs
StatePublished - Feb 2014

Keywords

  • Cisplatin
  • Neoadjuvant chemotherapy
  • Non-small-cell lung cancer
  • Pemetrexed
  • Pharmacogenetics

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

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