Favorable Response to Pemetrexed as a Salvage Agent for Patients with Advanced Lung Cancer Who Have Failed Conventional Platinum-Based Chemotherapy and EGFR Tyrosine Kinase Inhibitors

Background: For locally advanced or metastatic non-squamous non-small cell lung cancer
(NSCLC), pemetrexed is currently recommended as first-line treatment in combination with
platinum agents or second-line chemotherapy after the disease has become refractory to platinum-based
doublet regimens, but few reports have addressed its role as salvage chemotherapy
after failure of multiple therapies and the relationship between response rate and EGFR and
K-ras mutations.
Methods: We retrospectively evaluated the efficacy of pemetrexed in 11 patients with advanced
NSCLC, who had failed at least platinum-based doublet combinations and erlotinib or gefitinib.
The gender, performance status, number of cycles given, EGFR and K-ras mutation status, best
response, adverse reactions, time to progression (TTP) and overall survival (OS) were used to
assess the effects.
Results: A median of 6.17 cycles of infusion was given. Six out of 11 patients experienced partial
response, three stable disease and two disease progression. The TTP and OS of salvage pemetrexed
therapy were 108 and 346 days, respectively. The EGFR mutation status did not affect
its efficacy. It was well-tolerated and required no dose modification.
Conclusions: Pemetrexed is a good option for patients with good performance status who have
failed platinum- and taxane-containing regimens and EGFR tyrosine kinase inhibitors.