Pemetrexed Maintenance: Do NSCLC Patients Benefit?
Pemetrexed Maintenance: Do NSCLC Patients Benefit?
Hi. This is Mark Kris from Memorial Sloan-Kettering in New York talking about topics that were raised at the American Society of Clinical Oncology (ASCO®) meeting this year. A very important one -- a question that we needed answered -- was answered by Luis Paz-Ares and the other investigators on the PARAMOUNT trial: "Is there a role for continuation maintenance pemetrexed?"
We have all seen the data that pemetrexed, given as so-called "switch maintenance," improves both progression-free survival and overall survival in the clinical trials that have shown its effectiveness and that have led to its regulatory approval. At the same time, however, the use of pemetrexed has shifted from its original second-line use to first-line use. On the basis of the Scagliotti trial done many years ago, that the combination of pemetrexed plus cisplatin was clearly superior in terms of response rate, progression-free survival, and overall survival to the combination of gemcitabine and cisplatin, individuals have moved up pemetrexed to the first-line setting, and regulatory approval has also been obtained for that use as well as approval in our various guidelines.
It has seemed to be an important point to find out whether you could achieve benefits by continuing pemetrexed. It was a question that wasn't answered until the ASCO® meeting, and the well-done PARAMOUNT trial by Dr. Paz-Ares and his co-investigators indeed showed a progression-free survival benefit.
Doctors who now treat patients initially with pemetrexed can feel confident in continuing it. To me, continuation maintenance is the ultimate in targeted therapy. We always want to know what therapy is good for a certain patient, in terms of both benefit and side effects. The truth is that continuation maintenance is the ultimate targeted therapy because we are only continuing that therapy in patients in whom we have objective benefit, on the basis of our imaging studies and physical examinations, and in whom we have the patients' assurance and agreement that it is either maintaining or improving their lives. Lastly, we use it only when we know that the side effects are acceptable. We have already given the treatment; we know that we can safely give it; and we know that the side effects are acceptable to patients.
Maintenance is clearly a way to improve our results in the treatment of non-small cell lung cancer. It's a step -- many would say a small step -- but an important step nonetheless in improving the time free of cancer for all of our patients. Unlike any other situation we have in oncology, we know for sure that the treatment is helping patients; that patients have told us that the overall experience of receiving that medication is acceptable; and that the side effects are acceptable. I hope that we will all be able to use this information about continuation maintenance therapy, the ultimate targeted therapy, to develop more situations in which we knew when we were continuing a drug that it was helping patients in an important way.
Hi. This is Mark Kris from Memorial Sloan-Kettering in New York talking about topics that were raised at the American Society of Clinical Oncology (ASCO®) meeting this year. A very important one -- a question that we needed answered -- was answered by Luis Paz-Ares and the other investigators on the PARAMOUNT trial: "Is there a role for continuation maintenance pemetrexed?"
We have all seen the data that pemetrexed, given as so-called "switch maintenance," improves both progression-free survival and overall survival in the clinical trials that have shown its effectiveness and that have led to its regulatory approval. At the same time, however, the use of pemetrexed has shifted from its original second-line use to first-line use. On the basis of the Scagliotti trial done many years ago, that the combination of pemetrexed plus cisplatin was clearly superior in terms of response rate, progression-free survival, and overall survival to the combination of gemcitabine and cisplatin, individuals have moved up pemetrexed to the first-line setting, and regulatory approval has also been obtained for that use as well as approval in our various guidelines.
It has seemed to be an important point to find out whether you could achieve benefits by continuing pemetrexed. It was a question that wasn't answered until the ASCO® meeting, and the well-done PARAMOUNT trial by Dr. Paz-Ares and his co-investigators indeed showed a progression-free survival benefit.
Doctors who now treat patients initially with pemetrexed can feel confident in continuing it. To me, continuation maintenance is the ultimate in targeted therapy. We always want to know what therapy is good for a certain patient, in terms of both benefit and side effects. The truth is that continuation maintenance is the ultimate targeted therapy because we are only continuing that therapy in patients in whom we have objective benefit, on the basis of our imaging studies and physical examinations, and in whom we have the patients' assurance and agreement that it is either maintaining or improving their lives. Lastly, we use it only when we know that the side effects are acceptable. We have already given the treatment; we know that we can safely give it; and we know that the side effects are acceptable to patients.
Maintenance is clearly a way to improve our results in the treatment of non-small cell lung cancer. It's a step -- many would say a small step -- but an important step nonetheless in improving the time free of cancer for all of our patients. Unlike any other situation we have in oncology, we know for sure that the treatment is helping patients; that patients have told us that the overall experience of receiving that medication is acceptable; and that the side effects are acceptable. I hope that we will all be able to use this information about continuation maintenance therapy, the ultimate targeted therapy, to develop more situations in which we knew when we were continuing a drug that it was helping patients in an important way.
