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07-05-2013 | Oncology | Article

Burden of symptoms could guide NSCLC pemetrexed use


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medwireNews: Symptom burden and performance status may help identify the patients with non-squamous non-small-cell lung cancer (NSCLC) who are likely to respond to maintenance pemetrexed therapy, phase III trial findings suggest.

The post hoc analysis indicates that both progression-free survival and overall survival were significantly predicted by the lung cancer symptom scale (LCSS) average symptom burden index (ASBI) - calculated using loss of appetite, fatigue, cough, dyspnea, pain, and hemoptysis - and Eastern Cooperative Oncology Group performance status (PS).

"The LCSS ASBI and PS provide an incremental value for clinical decision-making in addition to other disease and clinical characteristics that can help to identify non-squamous NSCLC patients who may benefit differentially from pemetrexed maintenance therapy," say Coleman Obasaju (Eli Lilly and Company, Indianapolis, Indiana, USA) and co-authors.

The team examined data on patients with baseline ASBI information, including 314 patients given maintenance pemetrexed and 150 given placebo following initial non-pemetrexed induction therapy.

Patients with a low symptom burden (LSB), defined as an ASBI score below 25, had significantly longer progression-free survival (5.1 vs 2.4 months, hazard ratio [HR]=0.49) and overall survival (17.5 vs 11.0 months, HR=0.63) when treated with pemetrexed than placebo, after adjustment for clinical and demographic confounders.

Similarly, patients with a high symptom burden , defined as an ASBI score of 25 or above, had significantly better progression-free survival (3.7 vs 2.8 months HR=0.50) when treated with pemetrexed than placebo, but did not achieve significantly better overall survival.

Patients with a favorable PS of 0 - determined using eight factors including age, smoking status, race, disease stage, brain metastases, and receipt of platinum therapy - who received pemetrexed had significantly better progression-free survival (5.5 vs 1.7 months, HR=0.36) and overall survival (17.7 vs 10.3 months, HR=0.54) than placebo-treated patients.

But patients with a less favorable PS of 1 who were given pemetrexed only had significantly better progression-free survival than placebo-treated counterparts (HR=0.60).

"These data suggest that pemetrexed maintenance therapy is a useful treatment strategy for non-squamous NSCLC patients, especially those with LSB (minimal or no symptoms) or patients with PS 0 at successful completion of induction therapy," Obasaju et al conclude in the Annals of Oncology.

"Prespecified analyses evaluating patient-reported symptoms as predictive factors are warranted to further test the validity of these results," they say.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Lynda Williams, Senior medwireNews Reporter

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