ALIMTA AND TARCEVA EQUALLY EFFECTIVE FOR NSCLC 

NEW YORK (Reuters Health) May 21 - Pemetrexed and erlotinib were equally effective in pretreated patients with lung cancer, in a trial conducted in Greece.
An Italian investigator not involved with the Greek study, Dr. Cesare Gridelli, told Reuters Health by email that it "confirms that to date we have no data to prefer chemotherapy or targeted therapy with erlotinib as second-line treatment of unselected patients with advanced non small cell lung cancer."
The new study was the first multicenter randomized trial exclusively in Caucasian patients with metastatic non-small cell lung cancer who progressed after one or two lines of treatment.
As reported May 9th online in Cancer, Dr. Vassilis Georgoulias of University General Hospital of Heraklion and colleagues randomized 357 patients to receive pemetrexed or erlotinib in a phase III trial. All patients were followed until disease progression or death.
After a median follow-up of roughly 28 months, disease progression was documented in 150 pemetrexed patients and 153 in the erlotinib group. There was also no difference in the median time to progression (3.0 vs 3.9 months) or in overall survival.
Analysis of time to progression in the 36 patients in the pemetrexed group and the 39 in the erlotinib group with squamous cell histology showed the superiority of erlotinib in this subgroup (4.1 vs 2.5 months).
Overall, the incidence of grade 3 and 4 neutropenia, thrombocytopenia, and asthenia was significantly higher with pemetrexed. The incidence of grade 3 and 4 skin rash was higher in the erlotinib arm.

Another finding was that no patients with KRAS mutation tumors responded to erlotinib, although there were two responders in the pemetrexed arm. Patients with this marker did appear to benefit more in terms of disease control rate and overall survival when they received pemetrexed.
Thus, Dr. Georgoulias says, "analysis of certain gene mutations indicates once more the importance of molecular analysis for decision making and individualizing treatment for this lethal cancer type."
Dr. Gridelli, of Azienda Ospedaliera S.G. Moscati in Avellino, Italy concluded, "The choice should be guided according to previous response to first-line chemotherapy, toxicity reported, and patients' preference (oral vs intravenous chemotherapy)."
SOURCE: http://bit.ly/10iM2uv
Cancer 2013.