Objective For the dispute on the superiority of the pemetrexed compared with the docetaxel for treating advanced non-small-cell lung cancer (NSCLC), this study is conducted to evaluate the efficacy and safety of pemetrexed versus docetaxel for patients with NSCLC. Methods Such databases as The Cochrane Library, PubMed, EMBASE, SCI, CBM, CNKI, and VIP were searched to collect the randomized controlled trials (RCTs) about pemetrexed versus docetaxel for the treatment of NSCLC published before November of 2010. Two reviewers independently screened the studies, extracted the data and assessed the methodology quality. RevMan 5.0 software was used for meta-analyses. Results Five studies involving 847 patients were included. The results of meta-analyses showed that, in the aspect of efficacy, there was no significant difference between the two groups in the effective rate (OR=1.09, 95%CI 0.7 to 1.70), the disease control rate (OR=0.99, 95%CI 0.75 to 1.31), and the one-year survival rate (OR=1.11, 95%CI 0.56 to 2.18); in the aspect of safety, compared with docetaxel, pemetrexed could reduce the neutropenia (OR=0.09, 95%CI 0.05 to 0.15), the febrile neutropenia (OR=0.13, 95%CI 0.06 to 0.29) and the alopecia (OR=0.20, 95%CI 0.12 to 0.33), but no significant difference was found in haemoglobin (OR=1.45, 95%CI 0.23 to 9.06), thrombocytopenia (OR=1.46, 95%CI 0.59 to 3.59), nausea and vomiting (OR=1.23, 95%CI 0.53 to 2.83) and fatigue and debilitation (OR=0.73, 95%CI 0.40 to 1.30). Conclusion As the current evidence shows, pemetrexed has similar efficacy to docetaxel for advanced NSCLC patients, but it has fewer side effects of neutropenia, febrile neutropenia and alopecia.
ObjectiveTo compare the recent efficiency and toxicity reactions of pemetrexed plus cisplatin and paclitaxel plus cisplatin for advanced lung adenocarcinoma. MethodsOne hundred and twenty-four patients with advanced lung adenocarcinoma treated in our hospital between January 2009 and December 2012 were divided into pemetrexed plus cisplatin group (group PP, n=63) and paclitaxel plus cisplatin group (group TP, n=61). The effect was evaluated after two courses of treatment, and the toxicity reactions were evaluated every course. ResultsThe objective response rate, disease control rate and progression-free survival in group PP and TP were respectively 58.7% vs 37.7%, 74.6% vs 52.5%, and 6.1 months vs 4.5 months, with significant differences (P<0.05). The incidence of nausea and vomiting, and white blood cell decrease (neutropenia) in group PP were significantly lower than that in group TP (χ2=16.164, P<0.001; χ2=9.469, P=0.002). There were no significant differences in incidence of thrombocytopenia, anemia and hepatic function damage (χ2=0.098, P=0.755; χ2=0.267, P=0.606; χ2=0.006, P=0.973). ConclusionPemetrexed plus cisplatin shows obviously superior effects and fewer side effects on advanced lung adenocarcinoma compared with paclitaxel plus cisplatin regime.
ObjectiveTo systematically review the efficacy and safety of gefitinib versus pemetrexed as second-line treatment for advanced non-small cell lung cancer (NSCLC). MethodsDatabases including PubMed, The Cochrane Library (Issue 4, 2016), EMbase, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) about gefitinib versus pemetrexed as second-line treatment for advanced NSCLC from inception to April 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 11 RCTs involving 1 005 patients were finally included. The results of meta-analysis showed that: the rate of progression free survival (PFS) in the gefitinib group was superior to the pemetrexed group (HR=0.59, 95%CI 0.47 to 0.73, P<0.000 01). However, there were no significant differences between two groups in overall response rate (RR=1.28, 95%CI 0.86 to 1.90, P=0.22), disease control rate (RR=0.92, 95%CI 0.77 to 1.12, P=0.41) and the rate of overall survival (HR=0.75, 95%CI 0.56 to 1.01, P=0.05). The incidences of skin rash (RR=8.72, 95% CI 3.65 to 20.84, P<0.000 01) and diarrhea (RR=2.87, 95% CI 1.29 to 6.38, P=0.01) were significantly higher, but the incidences of neutropenia (RR=0.12, 95%CI 0.05 to 0.26, P<0.000 01) and fatigue (RR=0.46, 95%CI 0.30 to 0.72, P=0.000 6) were lower in the gefitinib group than those in the pemetrexed group. ConclusionGefitinib shows more superiority to pemetrexed, and it can be used as the second-line drug for advanced NSCLC． Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.
ObjectivesTo systematically review the efficacy and safety of the first generation EGFR-TKIs versus pemetrexed as second-line treatment for advanced non-small cell lung cancer (NSCLC).MethodsDatabases including PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM were searched to collect randomized controlled trials (RCTs) about the first generation EGFR-TKIs versus pemetrexed as second-line treatment for advanced NSCLC from inception to June 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 20 RCTs involving 2 242 patients were finally included. The results of meta-analysis showed that: the rate of progression free survival (PFS) in the EGFR-TKI group was superior to the pemetrexed group (HR=0.78, 95%CI 0.58 to 0.99, P<0.000 1) with significant difference. However, there was no significant difference between two groups in complete remission rate (RR=1.81, 95%CI 0.65 to 5.07,P=0.26), partial remission rate (RR=0.93, 95%CI 0.78 to 1.11, P=0.44), stable disease rate (RR=0.92, 95%CI 0.82 to 1.03, P=0.16), progression disease rate (RR=1.09, 95%CI 0.99 to 1.20, P=0.09), overall response rate (RR=0.97, 95%CI 0.72 to 1.30, P=0.84), disease control rate (RR=0.93, 95%CI 0.87 to 1.01, P=0.07) and overall survival rate (HR=0.89, 95%CI 0.74 to 1.04, P<0.572). The incidences of skin rash (RR=12.43, 95%CI 3.98 to 38.84,P<0.01) and diarrhea (RR=3.94, 95%CI 2.32 to 6.70,P<0.01) were significantly higher in the EGFR-TKI group, but the incidences of leukopenia (RR=0.19, 95%CI 0.09 to 0.41,P<0.01 ), anemia (RR=0.40, 95%CI 0.17 to 0.92,P=0.03), thrombocytopenia (RR=0.37, 95%CI 0.14 to 0.97, P=0.04), nausea and vomiting (RR=0.50, 95%CI 0.28 to 0.87, P=0.01), constipation (RR=0.30, 95%CI 0.14 to 0.64, P=0.002) were significant lower in the EGFR-TKI group than that of the pemetrexed group.ConclusionGefitinib shows some superiority to pemetrexed in second-line treatment for NSCLC, and it can be used as the second-line drug for advanced NSCLC. Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.