Better survival in impaired renal function patients with metastatic non-small cell lung cancer treated by cisplatin-pemetrexed

• Published in: European journal of clinical pharmacology 2020-11, Vol.76 (11), p.1573-1580
• Main Authors: Magali, Louis, Pascal, Foucher, Serge, Aho, Mathieu, Boulin, Ayoube, Zouak, Claire, Tinel, Christiane, Mousson
• Format: Article
• Language: English
• Subjects: Biomedical and Life Sciences; Biomedicine; Pharmacoepidemiology and Prescription; Pharmacology/Toxicology
• ISSN: 0031-6970; 1432-1041
• DOI: 10.1007/s00228-020-02935-8

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 m 2 ) and G2 (GFR between 60 and 89 mL/min/1.73 m 2 ). 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 m 2 (− 22.3%, p  = 0.001) in G1 and. 13.8 mL/min/1.73 m 2 (− 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 m 2 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.