Can patient factors predict whether chemotherapy will be effective?

This meta-analysis examined whether there were specific patient factors which would help predict the effectiveness of the anti-cancer drug pemetrexed (Alimta). The authors concluded that several factors including smoking status, genetic mutations, metastatic location and amount of tumors gave indications on whether or not pemetrexed would be beneficial to patients treated for non-squamous non-small-cell lung cancer. 

 

 

 

Lung cancer has poor survival rates mainly due to the fact that in many cases, the cancer has already spread at the time of diagnosis (metastatic). To overcome this issue, treatments need to be optimized to improve clinical outcomes for patients. Pemetrexed is a commonly used chemotherapy agent for non-squamous non-small-cell lung cancer (NSCLC). Knowing what factors, such as gender or smoking status, could help to predict the effectiveness of pemetrexed in treating this type of cancer would be useful for treatment planning.

 

 

This meta-analysis aimed to identify predictive factors in patients that would suggest whether pemetrexed was likely to be effective or not. 314 patients with non-squamous NSCLC treated with pemetrexed were included. 92 patients were classed as good responders, while 222 patients were classed as poor responders based on time to disease progression. 

 

For good responders, progression free survival (time from beginning of trial until disease progression/death) was an average of 29.9 months, compared to 1.4 months in poor responders. 

 

The study identified a number of factors predictive of pemetrexed effectiveness. Patients who had never smoked had double the chance of good response compared to those who had smoked. Patients with a genetic mutation (change) known as ALK gene rearrangement tended to be good responders. In contrast, patients with a mutation known as EGFR had a 48% lower chance of being a good responder. Having 2 or more metastatic sites resulted in a 34% lower chance of being a good responder. Finally, patients who had metastatic tumors in the abdomen were 41% less likely to be good responders. 

 

 

The authors concluded that pemetrexed is more effective for patients who have never smoked and have ALK gene rearrangement. Pemetrexed is less effective for patients with EGFR mutation, 2 or more metastatic sites and tumors in the abdomen. 

 

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