Table of Contents
Chemotherapy Research and Practice
Volume 2017 (2017), Article ID 8196434, 4 pages
Clinical Study

Efficacy of Second-Line Pemetrexed-Carboplatin in EGFR-Activating Mutation-Positive NSCLC: Does Exon 19 Deletion Differ from Exon 21 Mutation?

1Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
2Centre for Cancer Epidemiology, ACTREC, Tata Memorial Centre, Mumbai, India
3Department of Pathology, Tata Memorial Hospital, Mumbai, India
4Department of Radiology, Tata Memorial Hospital, Mumbai, India
5Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, India

Correspondence should be addressed to Kumar Prabhash

Received 18 April 2017; Revised 6 September 2017; Accepted 26 September 2017; Published 23 October 2017

Academic Editor: Naoya Fujita

Copyright © 2017 Amit Joshi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. It is unknown whether the outcomes of second-line pemetrexed-carboplatin chemotherapy administered after progression on gefitinib are dependent on type of EGFR mutation present at baseline. Method. Adult non-small-cell lung cancer patients, with exon 19 deletion or exon 21 L858R mutation, who progressed on gefitinib and received pemetrexed-carboplatin chemotherapy were selected for this analysis. Result. 55 patients received pemetrexed-carboplatin as second-line treatment. Response rates in evaluable patients were 39.3% in exon 19 patients () and 33.3% in exon 21 patients () (, Fisher’s exact 2-sided value). The median PFS in exon 19 and 21 cohorts was 5.900 months (95% CI: 4.274–7.526) and 4.767 months (95% CI: 1.374–8.159), respectively. The median overall survival in exon 19 patients was (11.8 months, 95% CI: 9.916–13.684 months) significantly better than that seen in exon 21 mutation patients (6.2 months, 95% CI: 4.215–8.118 months, = 0.024) on univariate analysis; however, on multivariate analysis, this association was not confirmed (HR = 0.361, 95% CI: 0.090–1.439, = 0.149). Conclusion. Exon 19 deletion has no impact on PFS and OS in EGFR-mutated patients treated with second-line pemetrexed-carboplatin.