Adjuvant Therapy for Completely Resected Advanced Nonsquamous NSCLC
Posted: Tuesday, July 16, 2019
According to research by Hirotsugu Kenmotsu, MD, of the Shizuoka Cancer Center, Shizuoka, Japan, and colleagues, postoperative adjuvant pemetrexed plus cisplatin did not improve survival compared with vinorelbine plus cisplatin in patients with completely resected stage II to IIIA nonsquamous non–small cell lung cancer (NSCLC). However, the pemetrexed combination had similar efficacy and appeared to be better tolerated than therapy with vinorelbine plus cisplatin. The findings of the JIPANG study were presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago (Abstract 8501).
In this phase III superiority trial, 804 patients were randomly assigned after complete resection to receive either pemetrexed plus cisplatin or vinorelbine plus cisplatin. Of the 784 patients included in the efficacy analysis, 389 and 395 patients were enrolled in the pemetrexed and vinorelbine arms, respectively.
With a median follow-up of 45.2 months, the median of recurrence-free survival was 38.9 months with pemetrexed plus cisplatin and 37.3 months with vinorelbine plus cisplatin (hazard ratio = 0.98, P = .948). The overall survival rate at 3 years was similar between the groups (83.5% vs. 87.2%, respectively). Interestingly, the hazard ratios in patients with and without EGFR mutations were 1.38 and 0.87, respectively (interaction, P = .046).
Despite no significant improvement in efficacy, pemetrexed plus cisplatin appeared to be better tolerated than vinorelbine plus cisplatin. The incidence of grade 3 or 4 febrile neutropenia (0.3% vs. 11.6%, P < .001), neutropenia (22.8% vs. 81.1%, P < .001), anemia (2.8% vs. 9.3%, P < .001), and any-grade alopecia (12.8% vs. 30.1%, P < .001) was significantly higher in the vinorelbine arm. More patients in the pemetrexed arm also completed treatment (87.9% vs. 72.7%, P < .001).
Disclosure: The study authors’ disclosure information may be found at coi.asco.org.
