Pemetrexed in maintenance treatment of advanced non-squamous non-small-cell lung cancer

Seigo Minami,1 Takashi Kijima2 1Department of Respiratory Medicine, Osaka Police Hospital, 2Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Osaka, Japan Abstract: Pemetrexed, a multitargeting antifolate cytotoxic drug, plays a leadi...

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Autores principales:	Minami S, Kijima T
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2015
Materias:	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/5313b41a4d4144faa9cfbe63f1541682
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spelling	oai:doaj.org-article:5313b41a4d4144faa9cfbe63f15416822021-12-02T00:34:22ZPemetrexed in maintenance treatment of advanced non-squamous non-small-cell lung cancer1179-2728https://doaj.org/article/5313b41a4d4144faa9cfbe63f15416822015-01-01T00:00:00Zhttp://www.dovepress.com/pemetrexed-in-maintenance-treatment-of-advanced-non-squamous-non-small-peer-reviewed-article-LCTThttps://doaj.org/toc/1179-2728 Seigo Minami,1 Takashi Kijima2 1Department of Respiratory Medicine, Osaka Police Hospital, 2Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Osaka, Japan Abstract: Pemetrexed, a multitargeting antifolate cytotoxic drug, plays a leading role in front-line chemotherapy for patients with advanced non-squamous non-small-cell lung cancer (NSCLC). Following its approval as second-line monotherapy for locally advanced or metastatic non-squamous NSCLC, pemetrexed has established itself as the first-line regimen in combination with cisplatin, and its powerful antitumor effects and less cumulative toxicities were then taken advantage of in the JMEN and PARAMOUNT trials, respectively, to pioneer a new treatment strategy of switch and continuation maintenance monotherapy. These developments have brought about a marked paradigm shift, and made pemetrexed indispensable in the treatment for non-squamous NSCLC. So far, only three drugs have been approved for maintenance therapy; pemetrexed both by switch and continuation maintenance, erlotinib by switch maintenance, and bevacizumab by continuation maintenance. Compared with observation alone after defined cycles of the first-line chemotherapy, subsequent pemetrexed maintenance therapy has provided significantly longer survival and infrequent severe adverse events. The cost-effectiveness of pemetrexed maintenance therapy is controversial, as well as the other two maintenance drugs, bevacizumab and erlotinib. The latest attractive attention is a combination maintenance therapy. We may have to consider epidermal growth factor receptor (EGFR) mutation status for selection of a combination pattern. A combination maintenance therapy of pemetrexed plus bevacizumab is potential for patients with wild-type EGFR status, while a EGFR tyrosine kinase inhibitor-containing combination is promising for patients with active EGFR mutation status. Pemetrexed will be a pivotal drug when a combination maintenance therapy is used in practice. For future maintenance therapy, we need to explore reliable predictive selection or exclusion markers that can predict who will really benefit from maintenance therapy. Keywords: pemetrexed, maintenance therapy, continuation, switch, non-squamous non-small cell carcinoma, cost-effectiveness, epidermal growth factor mutationMinami SKijima TDove Medical PressarticleNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENLung Cancer: Targets and Therapy, Vol 2015, Iss default, Pp 13-25 (2015)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Minami S Kijima T Pemetrexed in maintenance treatment of advanced non-squamous non-small-cell lung cancer
description	Seigo Minami,1 Takashi Kijima2 1Department of Respiratory Medicine, Osaka Police Hospital, 2Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Osaka, Japan Abstract: Pemetrexed, a multitargeting antifolate cytotoxic drug, plays a leading role in front-line chemotherapy for patients with advanced non-squamous non-small-cell lung cancer (NSCLC). Following its approval as second-line monotherapy for locally advanced or metastatic non-squamous NSCLC, pemetrexed has established itself as the first-line regimen in combination with cisplatin, and its powerful antitumor effects and less cumulative toxicities were then taken advantage of in the JMEN and PARAMOUNT trials, respectively, to pioneer a new treatment strategy of switch and continuation maintenance monotherapy. These developments have brought about a marked paradigm shift, and made pemetrexed indispensable in the treatment for non-squamous NSCLC. So far, only three drugs have been approved for maintenance therapy; pemetrexed both by switch and continuation maintenance, erlotinib by switch maintenance, and bevacizumab by continuation maintenance. Compared with observation alone after defined cycles of the first-line chemotherapy, subsequent pemetrexed maintenance therapy has provided significantly longer survival and infrequent severe adverse events. The cost-effectiveness of pemetrexed maintenance therapy is controversial, as well as the other two maintenance drugs, bevacizumab and erlotinib. The latest attractive attention is a combination maintenance therapy. We may have to consider epidermal growth factor receptor (EGFR) mutation status for selection of a combination pattern. A combination maintenance therapy of pemetrexed plus bevacizumab is potential for patients with wild-type EGFR status, while a EGFR tyrosine kinase inhibitor-containing combination is promising for patients with active EGFR mutation status. Pemetrexed will be a pivotal drug when a combination maintenance therapy is used in practice. For future maintenance therapy, we need to explore reliable predictive selection or exclusion markers that can predict who will really benefit from maintenance therapy. Keywords: pemetrexed, maintenance therapy, continuation, switch, non-squamous non-small cell carcinoma, cost-effectiveness, epidermal growth factor mutation
format	article
author	Minami S Kijima T
author_facet	Minami S Kijima T
author_sort	Minami S
title	Pemetrexed in maintenance treatment of advanced non-squamous non-small-cell lung cancer
title_short	Pemetrexed in maintenance treatment of advanced non-squamous non-small-cell lung cancer
title_full	Pemetrexed in maintenance treatment of advanced non-squamous non-small-cell lung cancer
title_fullStr	Pemetrexed in maintenance treatment of advanced non-squamous non-small-cell lung cancer
title_full_unstemmed	Pemetrexed in maintenance treatment of advanced non-squamous non-small-cell lung cancer
title_sort	pemetrexed in maintenance treatment of advanced non-squamous non-small-cell lung cancer
publisher	Dove Medical Press
publishDate	2015
url	https://doaj.org/article/5313b41a4d4144faa9cfbe63f1541682
work_keys_str_mv	AT minamis pemetrexedinmaintenancetreatmentofadvancednonsquamousnonsmallcelllungcancer AT kijimat pemetrexedinmaintenancetreatmentofadvancednonsquamousnonsmallcelllungcancer
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Pemetrexed in maintenance treatment of advanced non-squamous non-small-cell lung cancer

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