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Pemetrexed in the Treatment of Leptomeningeal Metastasis in Patients With EGFR-mutant Lung Cancer

Cited 2 time in Web of Science Cited 4 time in Scopus
Authors
Choi, Mihong; Keam, Bhumsuk; Ock, Chan-Young; Kim, Miso; Kim, Tae Min; Kim, Dong-Wan; Heo, Dae Seog
Issue Date
2019-07
Citation
Clinical Lung Cancer, Vol.20 No.4, pp.E442-E451
Keywords
Carcinomatous meningitisEpidermal growth factor receptorLeptomeningeal carcinomatosisNon-small-cell lung cancerPemetrexed
Abstract
The role of pemetrexed in the treatment of leptomeningeal metastasis (LM) was examined retrospectively in 110 patients with EGFR-mutant lung cancer. Pemetrexed use after LM was independently associated with a survival benefit for patients with LM. Introduction: Leptomeningeal metastasis (LM), still an area of unmet need, has frequently been observed in patients with EGFR-mutant non-small-cell lung cancer (NSCLC). Because the antitumor efficacy of systemic cytotoxic agents against LM is unclear, we explored the role of pemetrexed in the treatment of patients with LM from EGFR-mutant NSCLC. Patients and Methods: We retrospectively reviewed the medical records of patients with LM from EGFR-mutant NSCLC treated between 2006 and 2016. Post-LM survival was evaluated as well as clinical factors. Results: In our patient cohort with EGFR-mutant NSCLC (n = 631), 17.4% (n = 110) developed LM. Their median post-LM survival was 5.7 months (95% confidence interval, [CI], 0.0-12.0 months). Post-LM survival was significantly longer with pemetrexed use after LM (median, 13.7 months; 95% CI, 4.1-23.2 months) than without pemetrexed use after LM (median, 4.0 months; 95% CI, 2.2-5.7 months; P = .008). In the multivariate analyses, no pemetrexed use after LM (vs. use) and no EGFR tyrosine kinase inhibitor use after LM (vs. use) were independently associated with a poor post-LM survival with a hazard ratio of 3.1 (95% CI, 1.5-6.3; P = .002) and 3.0 (95% CI, 1.6-5.8; P = .001), respectively. Conclusion: Pemetrexed use after LM was independently associated with a longer post-LM survival in patients with EGFR-mutant NSCLC with LM. Prospective studies are warranted to validate this finding. (C) 2019 Elsevier Inc. All rights reserved.
ISSN
1525-7304
URI
https://hdl.handle.net/10371/165200
DOI
https://doi.org/10.1016/j.cllc.2019.03.005
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College of Medicine/School of Medicine (의과대학/대학원)Cancer Research Institute (암연구소)Journal Papers (저널논문_암연구소)
College of Medicine/School of Medicine (의과대학/대학원)Internal Medicine (내과학전공)Journal Papers (저널논문_내과학전공)
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