Prospective Observational Comparison of Clinical Outcomes Between African-American and Caucasian Patients Receiving Second-Line Treatment With Pemetrexed for Advanced Non-Small-Cell Lung Cancer

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• 作者：Eduardo Pennella ; Coleman K. Obasaju ; Gerhardt Pohl ; Gerson Peltz ; Allicia C. Girvan ; Katherine B. Winfree ; Betzaida Martinez ; Martin Marciniak ; Mark S. Walker ; Edward Stepanski ; Lee S. Schwartzberg ; Alex Adjei
• 关键词：Ethnicity ; Nonsquamous NSCLC ; Observational study ; Pemetrexed ; Symptoms
• 刊名：Clinical Lung Cancer
• 出版年：November, 2013
• 年：2013
• 卷：14
• 期：6
• 页码：726-735
• 全文大小：681 K

文摘

Introduction

This prospective observational study evaluated the effect of race on disease control rate (DCR), progression-free survival (PFS), and overall survival (OS) in patients with NSCLC treated with second-line pemetrexed.

Patients and Methods

Eligibility criteria included stage IIIB or IV NSCLC patients receiving single-agent pemetrexed for second-line therapy in routine clinical practice. Noninferiority was evaluated using logistic regression analysis of DCR, controlling for predefined covariates. Noninferiority was considered if the upper 95% confidence bound on the adjusted odds ratio (OR) for Caucasian vs. African-American individuals was less than 1.78, corresponding to a difference in proportion of 14% assuming Caucasian individuals to have a DCR of approximately 50%. The bound was chosen to be half of the anticipated difference between treatment and no second-line treatment. PFS and OS were estimated using the Kaplan-Meier method. Tools were used to measure functional status and symptom burden.

Results

The unadjusted DCR was 43.7% (117/268) for Caucasian and 45.0% (27/60) for African-American individuals (unadjusted OR, 0.95; 95% confidence interval [CI], 0.54-1.66). The adjusted OR in the final logistic regression model was 0.82 (95% CI, 0.43-1.58). This upper 95% confidence bound was within the prespecified acceptable bound of 1.78. Median PFS times (months) were 2.7 (95% CI, 2.4-3.4) for Caucasian and 3.0 (95% CI, 2.3-4.7) for African-American individuals (P聽= .91). Median OS times (months) were 6.7 (95% CI, 5.7-7.9) for Caucasian and 6.9 (95% CI, 4.5-8.9) for African-American individuals (P聽= .92). Baseline and functional status after baseline assessment and mean symptom burden did not differ substantially among races.

Conclusion

African-American race was not considered to be a significant predictor of disease control after second-line treatment with pemetrexed.