1. Intrathecal pemetrexed improves survival outcomes in previously treated EGFR-mutant advanced non-small-cell lung cancer with leptomeningeal metastases
- Author
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Liqun Li, Zhe Huang, Yangqian Chen, Hongzhi Ma, Xiaoquan Chen, Huan Yan, Haoyue Qin, Yuda Zhang, Xing Zhang, Wenjuan Jiang, Zhan Wang, Lin Zhang, Fanxu Zeng, Zhiguo Zhou, Xingxiang Pu, Nong Yang, Liang Zeng, and Yongchang Zhang
- Subjects
Intrathecal pemetrexed ,NSCLC ,Leptomeningeal metastases ,EGFR-TKI resistance ,Cerebrospinal fluid NGS ,Circulating tumor DNA ,Science (General) ,Q1-390 ,Social sciences (General) ,H1-99 - Abstract
Objective: This study assessed the impact of intrathecal pemetrexed (IP) in managing leptomeningeal metastases (LM) in previously treated patients with EGFR-mutant advanced non-small cell lung cancer (NSCLC). Methods: We analyzed the clinical and survival outcomes of 50 patients with LM who received 50 mg IP after disease progression with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) treatment between September 2021 and September 2023 at the Hunan Cancer Hospital. Treatment response was evaluated based on improvement in neurological symptoms/signs and Karnofsky Performance Status (KPS) scores. We also evaluated the overall survival (OS), intracranial progression-free survival (I-PFS), and extracranial progression-free survival (E-PFS). Next generation sequencing (NGS) was employed to explore the underlying mechanisms of LM after EGFR-TKIs resistance. Results: IP treatment was associated with a 64 % clinical response rate, median I-PFS of 5.3 months (95 % confidence intervals [CI], 1.4–9.2), E-PFS of 8.0 months (95 % CI, 2.2–13.8), and OS of 12.0 months (95 % CI, 9.6–14.4). Compared with non-responders, responders to IP demonstrated significantly prolonged I-PFS (11.2 months vs. 1.0 month; hazard ratio [HR]: 0.15, 95 % CI: 0.06–0.39), E-PFS (11.2 months vs. 3.0 months; HR: 0.24, 95 % CI: 0.10–0.57), and OS (15.5 months vs. 3.8 months; HR: 0.22, 95 % CI: 0.08–0.58) (all P
- Published
- 2024
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