Impact of pemetrexed on intracranial disease control and radiation necrosis in patients with brain metastases from non-small cell lung cancer receiving stereotactic radiation.

Abstract

BACKGROUND:

Pemetrexed is a folate antimetabolite used in the management of advanced adenocarcinoma of the lung. We sought to assess the impact of pemetrexed on intracranial disease control and radiation-related toxicity among patients with adenocarcinoma of the lung who received stereotactic radiation for brain metastases.

MATERIALS/METHODS:

We identified 149 patients with adenocarcinoma of the lung and newly diagnosed brain metastases without a targetable mutation receiving stereotactic radiation. Kaplan-Meier plots and Cox regression were employed to assess whether use of pemetrexed was associated with intracranial disease control and radiation necrosis.

RESULTS:

Among the entire cohort, 105 patients received pemetrexed while 44 did not. Among patients who were chemotherapy-naïve, use of pemetrexed (n = 43) versus alternative regimens after stereotactic radiation (n = 24) was associated with a reduced likelihood of developing new brain metastases (HR 0.42, 95% CI 0.22-0.79, p = 0.006) and a reduced need for salvage brain-directed radiation therapy (HR 0.36, 95% CI 0.18-0.73, p = 0.005). Pemetrexed use was associated with increased radiographic necrosis. (HR 2.70, 95% CI 1.09-6.70, p = 0.03).

CONCLUSIONS:

Patients receiving pemetrexed after brain-directed stereotactic radiation appear to benefit from improved intracranial disease control at the possible expense of radiation-related radiographic necrosis. Whether symptomatic radiation injury occurs more frequently in patients receiving pemetrexed requires further study.

• Authors: Daniel N Cagney, Allison M Martin, Paul J Catalano, Zachary J Reitman, Gabrielle A Mezochow, Eudocia Q Lee, Patrick Y Wen, Stephanie E Weiss, Paul D Brown, Manmeet S Ahluwalia, Nils D Arvold, Shyam K Tanguturi, Daphne A Haas-Kogan, Brian M Alexander, Amanda J Redig, Ayal A Aizer
• Journal: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology (Radiother Oncol) Vol. 126 Issue 3 Pg. 511-518 (03 2018) ISSN: 1879-0887 [Electronic] Ireland
• PMID: 29398153 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 Elsevier B.V. All rights reserved.

Chemical References

• Antineoplastic Agents
• Pemetrexed

Topics

• Adenocarcinoma (drug therapy, pathology, radiotherapy)
• Adenocarcinoma of Lung
• Aged
• Antineoplastic Agents (administration & dosage)
• Brain (pathology)
• Brain Neoplasms (drug therapy, radiotherapy, secondary, therapy)
• Female
• Humans
• Kaplan-Meier Estimate
• Lung Neoplasms (drug therapy, pathology, radiotherapy)
• Male
• Middle Aged
• Necrosis
• Pemetrexed (administration & dosage)
• Radiation Injuries (etiology, pathology)
• Radiosurgery (adverse effects, methods)
• Retrospective Studies