A meta-analysis of the safety and effectiveness of pemetrexed compared with gefitinib for pre-treated advanced or metastatic NSCLC.

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Tytuł:: A meta-analysis of the safety and effectiveness of pemetrexed compared with gefitinib for pre-treated advanced or metastatic NSCLC.
Autorzy:: Lu X; Department of Oncology.
Li S; Department of Pulmonary & Critical Care Medicine, Hainan Hospital of PLA General Hospital, Sanya.
Chen W; Xinglong Red Cross Hospital of Wanninng, Wanning City, Hainan Province, China.
Zheng D; Department of Pulmonary & Critical Care Medicine, Hainan Hospital of PLA General Hospital, Sanya.
Li Y; Department of Pulmonary & Critical Care Medicine, Hainan Hospital of PLA General Hospital, Sanya.
Li F; Department of Oncology.
Źródło:: Medicine [Medicine (Baltimore)] 2020 Jul 17; Vol. 99 (29), pp. e21170.
Typ publikacji:: Journal Article; Meta-Analysis; Systematic Review
Język:: English
Imprint Name(s):: Original Publication: Hagerstown, Md : Lippincott Williams & Wilkins
MeSH Terms:: Carcinoma, Non-Small-Cell Lung/*drug therapy
Gefitinib/*standards
Pemetrexed/*standards
Aged ; Antineoplastic Agents/standards ; Antineoplastic Agents/therapeutic use ; Antineoplastic Combined Chemotherapy Protocols/standards ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Female ; Gefitinib/therapeutic use ; Humans ; Male ; Pemetrexed/therapeutic use ; Progression-Free Survival
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Substance Nomenclature:: 0 (Antineoplastic Agents)
04Q9AIZ7NO (Pemetrexed)
S65743JHBS (Gefitinib)
Entry Date(s):: Date Created: 20200725 Date Completed: 20200803 Latest Revision: 20221005
Update Code:: 20240104
PubMed Central ID:: PMC7373595
DOI:: 10.1097/MD.0000000000021170
PMID:: 32702875
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Background: The purpose of the current meta-analysis was to compare the oncological outcomes of pemetrexed versus gefitinib in pre-treated advanced or metastatic non-small cell lung cancer (NSCLC) patients.
Methods: Search the online electronic databases on comparison the effectiveness and adverse effects of pemetrexed versus gefitinib in therapy outcomes of pre-treated NSCLC to September 2019. All studies analyzed the summary odds ratios (ORs) of the main outcomes, including survival efficacy and toxicity complications.
Results: In all, 5 trials involving 676 subjects were included, with 332 receiving pemetrexed and 344 using gefitinib. The pooled analysis of overall survival (OS) (OR = 0.97, 95%CI = 0.77-1.21, P = .76) and progression-free survival (PFS) (OR = 1.17, 95%CI = 0.60-2.30, P = .65) showed that pemetrexed did not achieve benefit when compared with gefitinib. In the results of subgroup analysis among the EGFR mutation-positive patients, the comparison of gefitinib therapy versus pemetrexed did show PFS benefit 0.35 (95%CI 0.12-1.01; P = .05). In terms of grade 3 or 4 side effects, a similar toxicity profile of both pemetrexed and gefitinib was shown in the incidence rate of rash (P = .045), fatigue (P = .97), thrombocytopenia (P = .68) and anemia (P = .21) between the 2 groups.
Conclusion: Pemetrexed was not associated with survival benefit than gefitinib therapy among pre-treated NSCLC patients. While, gefitinib showed superior PFS efficacy than pemetrexed for patients with EGFR mutation-type. Future investigations are required to identify relevant biomarkers in selected patients that would most likely benefit from pemetrexed or gefitinib treatment in pre-treated advanced NSCLC patients.

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