Pemetrexed plus platinum as the first-line treatment option for advanced non-small cell lung cancer: a meta-analysis of randomized controlled trials
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UNLABELLED: To compare the efficacy and toxicities of pemetrexed plus platinum with other platinum regimens in patients with previously untreated advanced non-small cell lung cancer (NSCLC). METHODS: A meta-analysis was performed using trials identified through PubMed, EMBASE, and Cochrane databases. Two investigators independently assessed the quality of the trials and extracted data. The outcomes included overall survival (OS), progression-free survival (PFS), response rate (RR), and different types of toxicity. Hazard ratios (HRs), odds ratios (ORs) and their 95% confidence intervals (CIs) were pooled using RevMan software. RESULTS: Four trials involving 2,518 patients with previously untreated advanced NSCLC met the inclusion criteria. Pemetrexed plus platinum chemotherapy (PPC) improved survival compared with other platinum-based regimens (PBR) in patients with advanced NSCLC (HR = 0.91, 95% CI: 0.83-1.00, p = 0.04), especially in those with non-squamous histology (HR = 0.87, 95% CI: 0.77-0.98, p = 0.02). No statistically significant improvement in either PFS or RR was found in PPC group as compared with PBR group (HR = 1.03, 95% CI: 0.94-1.13, p = 0.57; OR = 1.15, 95% CI: 0.95-1.39, p = 0.15, respectively). Compared with PBR, PPC led to less grade 3-4 neutropenia and leukopenia but more grade 3-4 nausea. However, hematological toxicity analysis revealed significant heterogeneities. CONCLUSION: Our results suggest that PPC in the first-line setting leads to a significant survival advantage with acceptable toxicities for advanced NSCLC patients, especially those with non-squamous histology, as compared with other PRB. PPC could be considered as the first-line treatment option for advanced NSCLC patients, especially those with non-squamous histology.
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Pemetrexed-based combination chemotherapy shows a slight but significant survival benefit compared with gemcitabine- or docetaxel-based combinations.
“Pemetrexed-based combination chemotherapy represents a therapeutic option, based on the results of a recent meta-analysis that showed a slight but significant survival benefit compared with gemcitabine-or docetaxel-based combinations and of a pre-planned subgroup analysis of a large randomised phase III trial [II, A] [54, 55].”
From Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up (2016) · cites this paper as [54]
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Pazhamalai, V., Govindarajan, M., Venkatesan, M., Rajkumar, J., Mathumida, R., Romauld, S. I., & Meenambiga, S. S. (2025) · IGI Global eBooks · doi:10.4018/979-8-3373-2096-0.ch010
Planchard, D., Janne, P. A., Yang, J. C. H., Kobayashi, K., Valdiviezo, N., Fan, Y., Kim, T. M., Gálvez, M. H. L., Nishino, K., Biswas, B., et al. (2026) · Lung Cancer · doi:10.1016/j.lungcan.2026.109588
- Authors
- Li, M., Zhang, Q., Fu, P., Li, P., Peng, A., Zhang, G., Song, X., Tan, M., Li, X., Liu, Y., Wu, Y., Fan, S., & Wang, C.
- Affiliations
- Tongji University (CN)
- Fudan University (CN)
- Corresponding author
- Wang, Changhui
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2012-05-17
- Volume
- 7
- Issue
- 5
- Pages
- e37229
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3355109
- OpenAlex
- W2088088880
- Cited by
- 67
- References
- 28
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 4 · 2022: 3 · 2021: 5 · 2019: 9 · 2018: 8 · 2017: 7 · 2016: 5 · 2015: 2 · 2014: 12 · 2013: 5 · 2012: 1
- FWCI
- 1.09
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- National Natural Science Foundation of China
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Health Sciences › Medicine › Oncology › Lung Cancer Research Studies
- Keywords
- pemetrexed, platinum-based chemotherapy, advanced non-small cell lung cancer, first-line therapy, overall survival, progression-free survival, response rate, hematologic toxicity, neutropenia, non-squamous histology, nausea
- MeSH terms
- Pemetrexed, Antineoplastic Combined Chemotherapy Protocols, Carcinoma, Non-Small-Cell Lung, Glutamates, Guanine, Humans, Lung Neoplasms, Organoplatinum Compounds, Treatment Outcome, Platinum Compounds, Disease-Free Survival
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