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S. Minami



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    P2.10 - Poster Session 2 - Chemotherapy (ID 207)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P2.10-007 - Phase II trial of Pemetrexed and Carboplatin followed by Pemetrexed continuation-maintenance therapy in previously untreated advanced non-small cell lung cancer (ID 679)

      09:30 - 09:30  |  Author(s): S. Minami

      • Abstract

      Background
      Survival benefits of pemetrexed for advanced non-squamous non-small cell lung cancer (NSCLC) have been demonstrated in both switch- and continuation-maintenance settings after platinum-based induction. A phase III trial (PARAMOUNT) comparing pemetrexed maintenance with best supportive care after 4 cycles of induction pemetrexed plus cisplatin in non-squamous NSCLC patients demonstrated benefits both in progression-free-survival (PFS) and overall survival (OS) by pemetrexed continuation-maintenance. However, it remained undetermined whether pemetrexed could improve survival when it was continued to administer after carboplatin plus pemetrexed induction. We conducted a phase II study to evaluate the efficacy and safety of this regimen.

      Methods
      Thirty-four chemonaïve patients with stage IIIB/IV or postoperative recurrent non-squamous NSCLC received carboplatin (area under the concentration-time curve 6 mg/mL/min, day 1) plus pemetrexed (500 mg/m[2], day 1) every 3 weeks. Non-progressive patients after 4 cycles of induction received pemetrexed maintenance (500 mg/m[2], day 1) every 3 weeks until disease progression or unacceptable toxicity. The primary objective was to investigate 1-year survival rate. Secondary objectives were to investigate the safety, the objective response rate (ORR) during induction chemotherapy and PFS, defined as the time from enrollment to disease progression or death.

      Results
      From December 2009 to March 2011, a total of 34 patients were enrolled. The median follow-up time was 20.9 months (range, 2 to 32.3). At the time of the data collection, 19 patients were dead, 13 still alive, 2 lost follow-up. Twenty-five patients (73.5%) completed induction and 22 patients (64.7%) received maintenance therapy. The 1-year survival rate was 70.3% (95% CI, 53.0 to 83.2). The 2-year survival rate was 45.5% (95% CI, 28.7 to 63.5). The median PFS and OS were 5.2 months (95% CI, 4.1 to 8.2) and 23.0 months (95% CI, 15.5 to not available) from enrollment in all 34 patients, in addition 9.0 months (95% CI, 5.2 to 12.1) and 24.3 months (95% CI, 17.8 to not available) from the start of maintenance therapy in 22 patients who proceeded to maintenance therapy. The objective response rate and the disease control rate were 32.4% and 88.2%. The incidental rates of grade 3 or more severe adverse events were low except for one case of grade 5 pneumonitis. A multivariate analysis of 21 patients who received maintenance therapy with any tumor regression showed that the longer time to the best response achievement, positive epidermal growth factor receptor mutation status and better Karnofsky performance status contributed to achieve longer PFS.

      Conclusion
      Pemetrexed continuation-maintenance following pemetrexed plus carboplatin induction is a promising treatment for chemonaïve patients with advanced non-squamous NSCLC because of its good efficacy and less cumulative toxicities. This regimen could be substitutable for pemetrexed continuation-maintenance following cisplatin-based induction.

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    P3.10 - Poster Session 3 - Chemotherapy (ID 210)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P3.10-019 - Oral S-1 and carboplatin followed by maintenance S-1 for chemo-naive patients with advanced squamous cell lung cancer (OSAKA-LCSG 1102) (ID 1384)

      09:30 - 09:30  |  Author(s): S. Minami

      • Abstract

      Background
      The subset analysis of LETS study suggested that S-1 plus carboplatin was more beneficial than paclitaxel plus carboplatin in overall survival (OS) in squamous cell lung cancer. We previously showed the validity of tailored dose S-1 adjusted by BSA and Ccr. No maintenance study focusing on squamous cell lung cancer has been reported yet. Here, we conducted a phase II study to evaluate the efficacy and safety of tailored dose S-1 plus carboplatin followed by S-1 maintenance in chemonaïve patients with advanced and recurrent squamous cell lung cancer.

      Methods
      Patients receive carboplatin (AUC = 5, day1) plus S-1 (tailored dose b.i.d., days 1-14) every 21 days. Non-progressive patients after 4 cycles of induction continued to receive S-1 until disease progression or unacceptable toxicity. The primary endpoint was objective response rate (ORR) with a threshold value of 15%. The secondary endpoints were progression-free survival (PFS) and OS from enrollment, PFS in maintenance phase, and safety.

      Results
      Between April 2011 and October 2012, 35 patients were enrolled. Thirty-three patients excluding 2 patients with protocol violations were analyzed. The median age was 72 years (range, 44-82), The ORR was 30.3% (95% CI: 15.6-48.7%) that met the primary endpoint. Disease control rate was 75.8%, and 10 patients (30.3%) received maintenance therapy. The median PFS was 3.7 months. The median OS and maintenance PFS are under follow-up. 10 patients received maintenance S-1 (median: 3 cycles, range: 1-9 cycles); median PFS from the beginning of induction treatment was 5.6 months. Grade 3/4 toxicities with the frequency more than 5% included 4 neutropenia (12.1%), 7 thrombocytopenia (21.2%), 2 anemia (6.1%), 4 appetite loss (12.1%), 2 nausea (6.1%) and 2 fatigue (6.1%). All of them were controllable and febrile neutropenia was not experienced.

      Conclusion
      This is the first trial of S-1 plus carboplatin followed by maintenance S-1 for chemo-naïve advanced and recurrent squamous cell lung cancer. This treatment strategy was effective and feasible.