Better survival in impaired renal function patients with metastatic non-small cell lung cancer treated by cisplatin-peme
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PHARMACOEPIDEMIOLOGY AND PRESCRIPTION
Better survival in impaired renal function patients with metastatic non-small cell lung cancer treated by cisplatin-pemetrexed Louis Magali 1
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& Foucher Pascal & Aho Serge & Boulin Mathieu & Zouak Ayoube & Tinel Claire & Mousson Christiane
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Received: 12 February 2020 / Accepted: 11 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Cisplatin-pemetrexed is the first-line chemotherapy for advanced, metastatic non-squamous non-small cell lung cancer (NSCLC), but the risk of kidney toxicity limits the therapeutic schedule. We performed a retrospective study of patient survival at 1 year and glomerular filtration rate (GFR) outcomes in cisplatin-pemetrexed-treated NSCLC patients. Methods Patients (P) treated for NSCLC between 2008 and 2014 were divided into two groups according to GFR at diagnosis: G1 (GFR ≥ 90 mL/min/1.73 m2) and G2 (GFR between 60 and 89 mL/min/1.73 m2). GFR were compared in the two groups at 3 and 12 months. The following statistical methods were used: multivariate generalized estimating equation model for GFR outcome, Kaplan-Meier method for patient survival rate, and Cox model for analysing survival criteria. Results A total of 112 patients were included in the study (G1 = 87 P, G2 = 25 P). At 12 months, mean GFR significantly decreased by 28.4 mL/min/1.73 m2 (− 22.3%, p = 0.001) in G1 and. 13.8 mL/min/1.73 m2 (− 17.2%, p = 0.001) in G2. Median patient survival was 9.6 months (1.1–52.4) in G1 and 19.7 months (3.7–56.9) in G2. A better overall survival was significantly correlated with GFR between 60 and 89 mL/min/1.73 m2 at diagnosis (p = 0.04), and higher cumulated doses of pemetrexed (p = 0.003) and cisplatin (p = 0.001). Conclusion The better survival rate in G2 and its correlation with pemetrexed and cisplatin treatments suggest that, until other therapeutic choices become available, a cautious increase in dosage could be investigated as a way to improve poor prognoses. Keywords Glomerular filtration rate . Non-squamous non-small cell lung cancer . Chronic renal failure . Cisplatin . Pemetrexed
Introduction Lung cancer is an ongoing public health problem, accounting for 11.1% of new cancer cases in France and 20.2% of cancer deaths [1]. Non-squamous non-small cell lung cancer (NSCLC) accounts for more than one-third of these cases, the majority of which are diagnosed at a metastatic stage [2].
* Louis Magali [email protected] 1
Nephrology Transplantation, University Hospital of Dijon, Dijon, France
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Department of Pneumology, University Hospital of Dijon, Dijon, France
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Department of Statistics and Epidemiology, University Hospital of Dijon, Dijon, France
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Department of Pharmacy, University Hospital of Dijon, Dijon, France
Cisplatin-pemetrexed is one of the first-line chemotherapies for NSCLC, but the nephrotoxicity of these two compounds and their metabolites is well established [3–6]. Furthermore, more than half of patients with lung cancer have a glomerular filtration rate (GF
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