Pembrolizumab Every 6 Weeks Versus Every 3 Weeks in Advanced Non-Small Cell Lung Cancer.

BACKGROUND: The survival benefits and adverse effects of pembrolizumab 2 mg/kg intravenously (IV) every 3 weeks (Q3W) in advanced non-small lung cancer (NSCLC) are well documented in the literature. Based on pharmacokinetic models, a pembrolizumab 4 mg/kg IV every 6 weeks (Q6W) dosing regimen is also approved in some countries. To date, there is no direct comparison in the literature between these 2 regimens in advanced NSCLC. METHODS: This retrospective study included 80 patients with advanced NSCLC who received pembrolizumab monotherapy 4 mg/kg Q6W between March 1, 2020 and December 31, 2021 and 80 patients with advanced NSCLC who received pembrolizumab monotherapy 2 mg/kg Q3W between January 1, 2017 and January 15, 2019 at Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ). The primary outcomes of this study were to compare overall survival (OS), progression-free survival (PFS) as well as the occurrence and severity of immune-mediated adverse events (AEs) in patients with advanced NSCLC who received pembrolizumab Q6W vs Q3W. Data cutoff date was December 15, 2022. RESULTS: Median follow-up was 14.5 ± 8.6 months in the Q6W group and 18.3 ± 19.6 months in the Q3W group. Median PFS was 6.9 months (CI 95% 5.0-10.7) in the Q6W group vs 8.9 months (CI 95% 5.6-14.1) in the Q3W group (adjusted HR 1.27 (CI 95% 0.85-1.89), P = .25). Median OS was not reached in the Q6W group vs 20.5 months (CI 95% 13.7-29.8) in the Q3W group (adjusted HR 0.80 (CI 95% 0.50-1.29), P = .36). Immune-mediated AEs of grade ≥ 3 occurred in 18% of patients in the Q6W group and in 19% of those in the Q3W group. CONCLUSIONS: In this unicentric retrospective study, the pembrolizumab Q6W dosing regimen was comparable to the Q3W in terms of OS, PFS, and toxicity.

Comparison between two premedication regimens of dexamethasone before a pemetrexed-based chemotherapy: A single-center experience study.

Pemetrexed, frequently used for the treatment of pulmonary adenocarcinoma, may cause cutaneous reactions that can be reduced with three oral doses of dexamethasone starting the day before treatment, and continuing after chemotherapy for a number of doses which varies according to the emetogenic potential of the protocol. Dexamethasone may induce side effects and no guideline suggests the conduct to favor when dexamethasone doses are omitted before treatment with pemetrexed. This study was performed to evaluate the efficacy of a simplified regimen of dexamethasone administered before a pemetrexed-based chemotherapy in preventing cutaneous toxicities. A prospective study was conducted with patients starting a pemetrexed-based treatment between February 2016 and August 2017 at the ambulatory oncology clinic of an academic hospital. Patients were divided into two groups, one receiving the usual oral premedication and the other receiving a 20-mg intravenous dose of dexamethasone prior to chemotherapy. Among the 70 patients included, 39 received the alternative regimen prior to a total of 114 chemotherapy cycles, while the other 31 patients received the usual premedication before a total of 154 cycles. The cutaneous toxicity incidence was of 10 events in the simplified treatment group compared to 9 events in the standard group (p = 0.35). These events occurred in nine patients within the experimental group and five patients within the control group (p = 0.56). A single intravenous dexamethasone regimen represents a valid alternative to the usual prophylaxis in preventing cutaneous reactions.

Effectiveness of adjuvant carboplatin-based chemotherapy compared to cisplatin in non-small cell lung cancer.

BACKGROUND: Cisplatin and vinorelbine given intravenously is a well-established adjuvant chemotherapy regimen after surgery for early non-small cell lung cancer. However, few validated alternatives exist when cisplatin is not indicated or tolerated. Carboplatin is frequently used in this setting. We evaluated the 5-year overall survival, progression-free survival and toxicity in patients treated for stage IB to IIIB resected non-small cell lung cancer receiving adjuvant carboplatin-based chemotherapy compared to cisplatin in association with vinorelbine. METHODS: Single-center retrospective study of patients having received adjuvant chemotherapy between January 2004 and December 2013 at the oncology clinic at Institut Universitaire de Cardiologie et de Pneumologie de Québec (Canada). Three sub-groups, cisplatin/vinorelbine, carboplatin/vinorelbine and the substitution of cisplatin/vinorelbine for carboplatin/vinorelbine (cisplatin/vinorelbine/carboplatin/vinorelbine), were studied during treatment. RESULTS: One hundred twenty-seven patients were included in this study. The median PFS was not significantly different, with 50.4 months for cisplatin/vinorelbine, 57.3 months for cisplatin/vinorelbine/carboplatin/vinorelbine and not yet achieved for the carboplatin/vinorelbine group ( p = 0.80). Overall survival also did not differ significantly between the three groups. The 5-year overall survival rates were 66% in cisplatin/vinorelbine group, 55% in carboplatin/vinorelbine group and 70% in cisplatin/vinorelbine/carboplatin/vinorelbine group ( p = 0, 95). No differences were noted between groups concerning high-grade hematologic toxicity. CONCLUSIONS: Although the effectiveness and hematologic toxicity are comparable between cisplat in and carboplatin in the adjuvant treatment of resected non-small cell lung cancer, the results obtained corroborate the practice used at our oncology clinic. Nevertheless, more prospective studies would be needed to confirm these results.