Posted: Monday, October 17, 2022
Postoperative adjuvant chemotherapy with pemetrexed plus cisplatin demonstrated similar recurrence-free survival outcomes and improved tolerability compared with vinorelbine plus cisplatin in patients with completely resected nonsquamous non–small cell lung cancer (NSCLC), based on the initial results of the phase III JIPANG trial. Now, the final analysis of the secondary study endpoint overall survival showed similar efficacy between the combination therapies in terms of overall survival for this population as well. The results of this final analysis of overall survival were presented by Kiyotaka Yoh, MD, of the National Cancer Center Hospital East, Kashiwa, Japan, and colleagues during the European Society for Medical Oncology (ESMO) Congress 2022 (Abstract 931MO).
“The overall survival with adjuvant pemetrexed plus cisplatin or vinorelbine plus cisplatin was one of the longest observed in this population compared with the historical data, regardless of EGFR mutation status,” the investigators reported.
In this trial, 804 patients with stage II–IIIA disease were randomly assigned in a 1:1 ratio to receive cisplatin in combination with either pemetrexed or vinorelbine. They were stratified based on sex, age, pathologic stage, EGFR mutation status, and institution. A total of 783 patients were evaluable for efficacy.
The updated median duration of recurrence-free survival was 43.4 months with pemetrexed and 37.5 months with vinorelbine (hazard ratio [HR] = 0.95; stratified one-sided log-rank test, P = .249). The overall survival rates at 3 and 5 years were 87.0% and 75.0% with pemetrexed versus 84.1% and 75.6% with vinorelbine, respectively, with a median follow-up of 77.3 months (HR = 1.04; P = .598). Based on the subgroup analysis of overall survival, the hazard ratio was 1.98 in patients with EGFR mutations and 0.86 in those without these mutations (interaction, P = .011). A total of 441 recurrences were observed; brain metastasis was reported in patients with (pemetrexed: 30.3%; vinorelbine: 18.6%) and without (pemetrexed: 18.6%; vinorelbine: 27.5%) EGFR mutations.
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