Survival Benefit of Pemetrexed in Lung Adenocarcinoma Patients With Anaplastic Lymphoma Kinase Gene Rearrangements

Sojung Park, Tai Sun Park, Chang Min Choi, Dae Ho Lee, Sang We Kim, Jung Shin Lee, Woo Sung Kim, Joon Seon Song, Jae Cheol Lee

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background There have been conflicting findings regarding the efficacy of pemetrexed for lung cancer with anaplastic lymphoma kinase (ALK) rearrangement. This study was conducted to explore the benefits of pemetrexed in this patient group. Patients and Methods Among patients who had received pemetrexed therapy between January 2010 and March 2014 for advanced stage lung adenocarcinoma, cases were selected with a confirmed ALK rearrangement, epidermal growth factor receptor (EGFR) mutation, or Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation. Clinical outcomes resulting from the pemetrexed-based regimen were analyzed according to the genetic alteration. Results A total of 442 patients were enrolled, including 52 with ALK translocation, 188 with EGFR mutation, 34 with KRAS mutation, and 168 wild type patients. The mean age was 57 ± 11 years and women were predominant in the ALK-positive and EGFR mutant groups. Pemetrexed-platinum combination therapy was usually performed as first-line therapy, whereas pemetrexed monotherapy was usually used as second-line therapy and beyond. The response rate (RR) was greater in the ALK-positive group than in the other groups (26.9% vs. 12.8%, 8.8%, and 18.5%; P =.046). The median progression-free survival (PFS) of ALK-positive patients was longer than that of the others (7.8 months vs. 2.5, 2.3, and 2.9 months; P <.001). This benefit on survival was more evident when pemetrexed was used as a single agent (P <.001). Conclusion ALK-positive patients showed a greater RR and longer PFS with pemetrexed-based therapy than patients without ALK rearrangements, suggesting that pemetrexed should be preferentially considered for the treatment of ALK-positive lung adenocarcinoma when use of crizotinib is not feasible.

Original languageEnglish
Article number347
Pages (from-to)e83-e89
JournalClinical Lung Cancer
Volume16
Issue number5
DOIs
StatePublished - 2015 Sep 1

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Pemetrexed
Gene Rearrangement
Survival
Epidermal Growth Factor Receptor
Mutation
Disease-Free Survival
Therapeutics
Adenocarcinoma of lung
anaplastic lymphoma kinase
Platinum
Oncogenes
Sarcoma
Lung Neoplasms

Keywords

  • Anaplastic lymphoma kinase
  • Lung cancer
  • Pemetrexed
  • Progression-free survival

Cite this

Park, Sojung ; Park, Tai Sun ; Choi, Chang Min ; Lee, Dae Ho ; Kim, Sang We ; Lee, Jung Shin ; Kim, Woo Sung ; Song, Joon Seon ; Lee, Jae Cheol. / Survival Benefit of Pemetrexed in Lung Adenocarcinoma Patients With Anaplastic Lymphoma Kinase Gene Rearrangements. In: Clinical Lung Cancer. 2015 ; Vol. 16, No. 5. pp. e83-e89.
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title = "Survival Benefit of Pemetrexed in Lung Adenocarcinoma Patients With Anaplastic Lymphoma Kinase Gene Rearrangements",
abstract = "Background There have been conflicting findings regarding the efficacy of pemetrexed for lung cancer with anaplastic lymphoma kinase (ALK) rearrangement. This study was conducted to explore the benefits of pemetrexed in this patient group. Patients and Methods Among patients who had received pemetrexed therapy between January 2010 and March 2014 for advanced stage lung adenocarcinoma, cases were selected with a confirmed ALK rearrangement, epidermal growth factor receptor (EGFR) mutation, or Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation. Clinical outcomes resulting from the pemetrexed-based regimen were analyzed according to the genetic alteration. Results A total of 442 patients were enrolled, including 52 with ALK translocation, 188 with EGFR mutation, 34 with KRAS mutation, and 168 wild type patients. The mean age was 57 ± 11 years and women were predominant in the ALK-positive and EGFR mutant groups. Pemetrexed-platinum combination therapy was usually performed as first-line therapy, whereas pemetrexed monotherapy was usually used as second-line therapy and beyond. The response rate (RR) was greater in the ALK-positive group than in the other groups (26.9{\%} vs. 12.8{\%}, 8.8{\%}, and 18.5{\%}; P =.046). The median progression-free survival (PFS) of ALK-positive patients was longer than that of the others (7.8 months vs. 2.5, 2.3, and 2.9 months; P <.001). This benefit on survival was more evident when pemetrexed was used as a single agent (P <.001). Conclusion ALK-positive patients showed a greater RR and longer PFS with pemetrexed-based therapy than patients without ALK rearrangements, suggesting that pemetrexed should be preferentially considered for the treatment of ALK-positive lung adenocarcinoma when use of crizotinib is not feasible.",
keywords = "Anaplastic lymphoma kinase, Lung cancer, Pemetrexed, Progression-free survival",
author = "Sojung Park and Park, {Tai Sun} and Choi, {Chang Min} and Lee, {Dae Ho} and Kim, {Sang We} and Lee, {Jung Shin} and Kim, {Woo Sung} and Song, {Joon Seon} and Lee, {Jae Cheol}",
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Survival Benefit of Pemetrexed in Lung Adenocarcinoma Patients With Anaplastic Lymphoma Kinase Gene Rearrangements. / Park, Sojung; Park, Tai Sun; Choi, Chang Min; Lee, Dae Ho; Kim, Sang We; Lee, Jung Shin; Kim, Woo Sung; Song, Joon Seon; Lee, Jae Cheol.

In: Clinical Lung Cancer, Vol. 16, No. 5, 347, 01.09.2015, p. e83-e89.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Survival Benefit of Pemetrexed in Lung Adenocarcinoma Patients With Anaplastic Lymphoma Kinase Gene Rearrangements

AU - Park, Sojung

AU - Park, Tai Sun

AU - Choi, Chang Min

AU - Lee, Dae Ho

AU - Kim, Sang We

AU - Lee, Jung Shin

AU - Kim, Woo Sung

AU - Song, Joon Seon

AU - Lee, Jae Cheol

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Background There have been conflicting findings regarding the efficacy of pemetrexed for lung cancer with anaplastic lymphoma kinase (ALK) rearrangement. This study was conducted to explore the benefits of pemetrexed in this patient group. Patients and Methods Among patients who had received pemetrexed therapy between January 2010 and March 2014 for advanced stage lung adenocarcinoma, cases were selected with a confirmed ALK rearrangement, epidermal growth factor receptor (EGFR) mutation, or Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation. Clinical outcomes resulting from the pemetrexed-based regimen were analyzed according to the genetic alteration. Results A total of 442 patients were enrolled, including 52 with ALK translocation, 188 with EGFR mutation, 34 with KRAS mutation, and 168 wild type patients. The mean age was 57 ± 11 years and women were predominant in the ALK-positive and EGFR mutant groups. Pemetrexed-platinum combination therapy was usually performed as first-line therapy, whereas pemetrexed monotherapy was usually used as second-line therapy and beyond. The response rate (RR) was greater in the ALK-positive group than in the other groups (26.9% vs. 12.8%, 8.8%, and 18.5%; P =.046). The median progression-free survival (PFS) of ALK-positive patients was longer than that of the others (7.8 months vs. 2.5, 2.3, and 2.9 months; P <.001). This benefit on survival was more evident when pemetrexed was used as a single agent (P <.001). Conclusion ALK-positive patients showed a greater RR and longer PFS with pemetrexed-based therapy than patients without ALK rearrangements, suggesting that pemetrexed should be preferentially considered for the treatment of ALK-positive lung adenocarcinoma when use of crizotinib is not feasible.

AB - Background There have been conflicting findings regarding the efficacy of pemetrexed for lung cancer with anaplastic lymphoma kinase (ALK) rearrangement. This study was conducted to explore the benefits of pemetrexed in this patient group. Patients and Methods Among patients who had received pemetrexed therapy between January 2010 and March 2014 for advanced stage lung adenocarcinoma, cases were selected with a confirmed ALK rearrangement, epidermal growth factor receptor (EGFR) mutation, or Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation. Clinical outcomes resulting from the pemetrexed-based regimen were analyzed according to the genetic alteration. Results A total of 442 patients were enrolled, including 52 with ALK translocation, 188 with EGFR mutation, 34 with KRAS mutation, and 168 wild type patients. The mean age was 57 ± 11 years and women were predominant in the ALK-positive and EGFR mutant groups. Pemetrexed-platinum combination therapy was usually performed as first-line therapy, whereas pemetrexed monotherapy was usually used as second-line therapy and beyond. The response rate (RR) was greater in the ALK-positive group than in the other groups (26.9% vs. 12.8%, 8.8%, and 18.5%; P =.046). The median progression-free survival (PFS) of ALK-positive patients was longer than that of the others (7.8 months vs. 2.5, 2.3, and 2.9 months; P <.001). This benefit on survival was more evident when pemetrexed was used as a single agent (P <.001). Conclusion ALK-positive patients showed a greater RR and longer PFS with pemetrexed-based therapy than patients without ALK rearrangements, suggesting that pemetrexed should be preferentially considered for the treatment of ALK-positive lung adenocarcinoma when use of crizotinib is not feasible.

KW - Anaplastic lymphoma kinase

KW - Lung cancer

KW - Pemetrexed

KW - Progression-free survival

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U2 - 10.1016/j.cllc.2015.01.003

DO - 10.1016/j.cllc.2015.01.003

M3 - Article

C2 - 25682546

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VL - 16

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