TITLE:
Predictive Factors of Severe Toxicities of Pemetrexed-Containing Chemotherapy in Patients with Non-Squamous Non-Small Cell Lung Cancer
AUTHORS:
Yuki Katsuya, Yuichiro Takeda, Go Naka, Haruhito Sugiyama
KEYWORDS:
Non-Squamous Non-Small Cell Lung Cancer, Pemetrexed, Toxicity, Clinical Settings
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.8 No.11,
November
28,
2017
ABSTRACT: Background: Pemetrexed (PEM) is an
efficacious multi-targeted antifolate with acceptable toxicities for
non-squamous non-small cell lung cancer (non-Sq NSCLC). However, in the
clinical setting, PEM has more severe adverse effects than those reported. The
aim of this study was to identify the factors for the toxicities of
PEM-containing chemotherapy in non-Sq NSCLC patients in the clinical setting. Patients and Methods: We retrospectively evaluated the
factors related to PEM toxicities in chemotherapy-naive patients with non-Sq
NSCLC from September 2009 to July 2013 at our hospital. Logistic regression
model was used in the univariate and multivariate analyses. Results: In
total, 104 patients were analyzed. Grades 3 to 5 hematologic toxicities were frequent
and included neutropenia (42%),
febrile neutropenia (7%), anemia (18%), thrombocytopenia (17%), and
disseminated intravascular coagulation (2%). On multivariate analyses, the
predictors were poor performance status (PS) [odds ratio (OR): 4.89, 95% confidence
interval (CI): 1.22 - 19.4] and low body mass index (OR: 1.44, 95% CI: 1.05 - 1.98) for febrile
neutropenia; concomitant chronic infectious disease (OR: 6.63, 95% CI: 1.59 - 27.5) and bevacizumab use
(OR: 3.57, 95% CI: 1.36 - 9.32) for neutropenia; poor PS (OR: 3.02, 95% CI: 1.33 - 6.85) for
thrombocytopenia; and low serum albumin level (OR: 0.22, 95% CI: 0.08
- 0.63) for non-hematologic toxicities. Conclusions: In addition to the previously reported predictors of PEM toxicities, the presence
of concomitant chronic infectious disease was associated with hematologic
toxicities. Patient groups who are not sufficiently evaluated in clinical
trials should be carefully monitored for the development of more toxicities
than expected.