Full-dose pemetrexed plus cisplatin combined with concurrent thoracic radiotherapy for previously untreated advanced nonsquamous non-small cell lung cancer

Compared with other platinum-based doublet chemotherapy, pemetrexed plus platinum is more effective and tolerable as the first-line treatment for nonsquamous non-small cell lung cancer (NSCLC). Thus, we examined the feasibility of using thoracic radiotherapy combined with concurrent full-dose pemetrexed as the first-line treatment for advanced nonsquamous NSCLC patients. From January 2009 to July 2012, 41 patients with stage IIIB or IV nonsquamous NSCLC were treated with full-dose pemetrexed plus cisplatin as the first-line chemotherapy combined with concurrent thoracic radiotherapy, with or without radiotherapy for metastases. The status of mutations in the epidermal growth factor receptor was unknown before the treatment, and no tyrosine-kinase inhibitor and cytotoxic drug maintenance therapy were administered to the patients after the chemotherapy. The median follow-up duration was 26.3 months (range, 5.8–57.5 months). Twenty-one patients had stage IIIB disease (19 with stage N3-IIIB). Of the 20 patients with stage IV disease, 16 had oligometastases (≤5) and four had polymetastases. The median number of chemotherapy cycles was 4. The median radiation dose was 60 Gy. Thirty-six patients received radical doses of radiotherapy. Toxicities were highly tolerated. The median progression-free survival was 12 months and the median overall survival was 32 months. The 1-, 2-, and 3-year overall survival rates were 87.5, 67.1, and 43.4%, respectively. As the first-line treatment for selected patients with advanced nonsquamous NSCLC, thoracic radiotherapy combined with concurrent full-dose pemetrexed plus cisplatin was safe and highly tolerable. In addition, the survival rate was encouraging. Prospective clinical trials are needed to verify the results.