Pemetrexed in the treatment of non-small cell lung cancer.

A large meta-analysis showed that chemotherapy results in significant prolongation of survival for patients with non-small cell lung cancer (NSCLC). Pemetrexed is a new multitargeted antifolate chemotherapeutic agent that has shown activity in NSCLC and appears to be similar to the third-generation antitumor agents currently in use today. In two phase I trials of pemetrexed in previously untreated patients with NSCLC, overall response rates of 16% and 23% were seen. The treatment was very well tolerated, particularly when dexamethasone premedication was used to prevent rash. In two phase II trials of pemetrexed and cisplatin, overall response rates rose to 39% and 45% with 1-year survival rates of 49% and 50%. Furthermore, in one of the trials, the response rate for stage IV patients was 45%. In the second-line treatment of NSCLC, 9% of patients responded to pemetrexed. The response rate in patients who had not previously received a cisplatin regimen was 14%, and 5% for patients previously treated with a platinum compound. A large randomized trial that compares treatment with pemetrexed to docetaxel in the second-line setting for NSCLC has recently completed accrual. In conclusion, pemetrexed is an active agent in the treatment of advanced NSCLC and represents a new option for the treatment of patients with this malignancy.