Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Efficacy of Pemetrexed in Relapsed Non-Small Cell Lung Cancer and Thymidylate Synthase Expression

재발성 비소세포폐암에서 Pemetrexed 치료 효과와 Thymidylate Synthase 발현의 관계

  • Park, Choel-Kyu (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Kyu-Sik (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Oh, In-Jae (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Tseden-Ish, Manaljav (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Choi, Yoo-Duk (Department of Pathology, Chonnam National University Medical School) ;
  • Kwon, Yong-Soo (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Yoo-Il (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Lim, Sung-Chul (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Young-Chul (Department of Internal Medicine, Chonnam National University Medical School)
  • 박철규 (전남대학교 의과대학 내과학교실) ;
  • 김규식 (전남대학교 의과대학 내과학교실) ;
  • 오인재 (전남대학교 의과대학 내과학교실) ;
  • ;
  • 최유덕 (전남대학교 의과대학 병리학교실) ;
  • 권용수 (전남대학교 의과대학 내과학교실) ;
  • 김유일 (전남대학교 의과대학 내과학교실) ;
  • 임성철 (전남대학교 의과대학 내과학교실) ;
  • 김영철 (전남대학교 의과대학 내과학교실)
  • Received : 2009.07.10
  • Accepted : 2009.08.25
  • Published : 2009.09.30
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Abstract

Background: Pemetrexed, a multi-targeted antifolate has been used as a second line treatment against non-small cell lung cancer (NSCLC). We aimed to clarify the efficacy and survival according to line of treatment, histologic type, and expression of thymidylate synthase (TS). Methods: Ninety-eight patients were treated with pemetrexed as a second line treatment (n=43) or as an additional course of treatment (n=55). TS expression was studied with immunohistochemistry and graded as 0 to 3 based on the extent of expression. Results: The response rate (RR) in 98 subjects was 10.2% and the disease control rate (DCR=PR+SD) was 30.6%. RR and DCR were 12.7% and 32.7% in non-squamous cell carcinoma (NSQC) compared to 7.0% and 27.9% in squamous cell carcinoma (SQC) (p>.05). No significant differences in RR and DCR were observed between a second line group (4.7%, 20.9%) and a further line group (14.5%, 38.2%). A similar trend was observed in the 88 response evaluable subjects. TS was expressed in 28.6% (grade 1), 24.5% (grade 2) and 7.1% (grade 3), respectively, and it was not expressed in 39.8% of subjects. TS expression rate was significantly higher in the SQC (72.1%) compared to NSQC (50.9%, p=0.033). However, the efficacy of pemetrexed was not significantly different by the extent of TS expression. Conclusion: Pemetrexed showed efficacy, not only in a second-line setting, but also in further lines of treatment for NSCLC. The efficacy of pemetrexed tended to be higher in patients with NSQC compared to SQC. TS expression rate was significantly higher in SQC compared to NSQC.

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References

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